2017 MEMBER DIRECTORY ENCLOSED

A publication for Wisconsins Long-Term Care Profession by SPRING 2017

The Faces of Long-Term Care

Profiling The Heroes on the Front Line
of Caring for Wisconsins Most Vulnerable Residents

Including: DHS Secretary Linda Seemeyer on the Future of LTC in Wisconsin

Informed, Involved, and In Control: RoP Changes to Residents Rights
Person-Centered Care and the Importance of Effective Planning
 ANALYZE
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WELCOME
Our Future is Bright
One thing that I have said throughout my career is that I have TBS
True Believer Syndrome. In my life I have always chosen jobs
for organizations whose missions I believe in. Serving as Executive
Director of the Wisconsin Health Care Association is no exception. It
is the greatest honor of my life to serve our assisted living and skilled
nursing facility members around the State of Wisconsin.
Every day I talk to facility managers and administrators about the
unique and common challenges they face. Once again this year,
Wisconsin has received the dubious distinction of being ranked as the
worst skilled nursing facility reimbursement system in the country.
At the same time, many assisted living facility providers have not
received rate increases in as many as eight years.
To be honest with you, Id rather not have to talk about reimbursement
all the time. I would love to have the opportunity to talk more about
advancing the quality of care provided in our member facilities and
what the Wisconsin Health Care Association and the Wisconsin
Center for Assisted Living are doing to advance the quality of long-
term care in the Badger State.
However, the quality of care that our member facilities are able
to provide is directly related to our ability to cover our costs. The
reality is that according to the latest data compiled in the skilled
nursing facility Medicaid loss report compiled by Eljay, LLC and
commissioned by our national organization, the American Health
Care Association, the average loss for facilities on a Medicaid patient
day is $58!
If it were just the fact that Wisconsin had the worst reimbursement
system in the country thatd be one thing
And if it were just the fact that Wisconsins LTC providers are
experiencing a crisis in the availability of frontline caregivers thatd
be one thing
And if it were just the fact that Family Care providers havent received
a rate increase in 5-8 years, thatd be one thing
And if it were just the fact that skilled nursing facilities have to deal with
a broken survey and enforcement system that thatd be one thing
But taken together, it is a lot for our members to shoulder. Thats why
WHCA/WiCAL and AHCA/NCAL are doing everything possible to
communicate to policymakers and regulators the need for reform.
And while the challenges are numerous, the long-term care provider
community in Wisconsin has been working tirelessly to raise
awareness of the need for reform and a recommitment to our elderly
and disabled residents.
Thanks to your advocacy efforts, Gov. Walker has included a
2 percent increase in skilled nursing facility Medicaid reimbursement
in each year of the biennium in his proposed budget. While we
appreciate Gov. Walkers support of the profession and believe that
it is an important step in the right direction, WHCA/WiCAL will
continue to advocate for SNF payment reform.
Thanks to our advocacy efforts, and our associations raising awareness
of the caregiver crisis, participation in the Quality Assurance and
Improvement Committee. $2.3 million in grant money has been
approved to fund the Wisconsin Caregiver Career Program, which
will provide training grants, and money for a promotional campaign
to attract caregivers to the profession.
Regarding an internal note, WHCA/WiCAL was pleased to announce
that this Spring we hired Jackie Strader, an experienced Registered
Nurse and Director of Nursing, as our new Director of Quality
Advancement and Regulatory Affairs, a position the association has
recently created to coordinate quality advancement and regulatory
affairs issues.
Ultimately, there are three reasons why I am optimistic about the
future of the profession of long-term care:
1. Dedicated Caregivers: I could not be more proud of
Wisconsins hard-working LTC provider community.
2. Extraordinary Residents: Too often it seems we focus on
our state and nations aging population as a problem to
be solved as opposed to the opportunity it presents. The
coming generations of seniors and super seniors will be the
most-educated aging population in human history. There
will be great opportunities to share from their considerable
base of knowledge.
3. Receptive Policymakers: Increasingly, legislators understand
the gravity of the workforce shortage and agree with
and acknowledge the need to invest in long-term care.
Lawmakers are now well-informed of the problem and are
willing to work with us toward a solution.
By working together, focusing on providing the best possible care to
the residents we serve, and clearly, consistently and effectively telling
the great story that we have to policymakers, press, and the public,
I am confident that the future is bright for long-term care!
John J. Vander Meer, MPA
Executive Director
Wisconsin Health Care Association
Spring 2017 | CONTINUUM 3
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4 CONTINUUM | www.whcawical.org
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Spring 2017

CONTENTS
6 CAPITOL CONNECTION
State Budget Outlook and the Future of Medicaid
The 2017-19 legislative session is in full swing, and the Legislatures Joint Finance Committee is in the middle
Continuum is published for the of biennial budget deliberation, in which lawmakers will determine state funding for LTC reimbursement for
Wisconsin Health Care Association the next two years. Governor Walker included $51.5 million for increased skilled nursing reimbursement over
and the Wisconsin Center for the next two years. WHCA/WiCALs government affairs team has been working with member facilities and
Assisted Living with legislators to maintain that funding, as well as increase funding for Family Care reimbursement. The state
budget debate is also occurring during a period of uncertainty regarding the future of Medicaid and the ACA,
131 W. Wilson Street, Suite #1001 as Republicans in Washington consider reforms.
Madison, WI 53703
Phone: 608.257.0125
Fax: 608.257.0025
www.whcawical.org
8 MEDIA MATTERS
Optimize Your Online Presence: Using Online Review Sites to
Benefit Your Census
More and more each day, consumers are relying on online reviews while considering products or services.
Industries from restaurants and hotels to golf courses to nail salons are working to embrace and grow within
a new online review reality. The long-term care provider community must see online reviews as a necessary
Managing Editor opportunity for future growth and success.
Jim Stoa

Publisher 10 STAKEHOLDER SPOTLIGHT

DHS Secretary Linda Seemeyer on the Future of LTC in Wisconsin
Dean Gille Secretary Linda Seemeyer was appointed by Governor Walker as Secretary of DHS in August 2016. The former
Editor Direcctor of the Walworth County Department of Health & Human Services, Sec. Seemeyer has overseen a
county-run nursing home and brings LTC bona fides to her role as the head of the state health department.
John Vander Meer
Seemeyer discusses her new position, the budget, the LTC workforce crisis, and the survey process in Wisconsin.
Account Manager
Melissa Keller
Creative Director
12 DATA DIGEST
PEAL: A Big Deal
Sara Rice How can your assisted living facility use data to make informed decisions? Through the Performance Excellence in
Assisted Living (PEAL) program, WiCAL members have detailed performance and quality data at their disposal,
Layout & Design helping facilities be in a much better position to continually achieve performance excellence. Participating
David Cox facilities will also be trained in recognized performance excellence criteria and quality improvement processes.
PEAL participants have access to a full curriculum of educational and professional growth opportunities.
Published by

14 COVER STORY
The Faces of Long-Term Care
1155 Wilburn Road Profiling the Heroes on the Front Line of Caring for Wisconsins Most Vulnerable Residents
Caring for our most vulnerable community members is perhaps the greatest responsibility we as a society
Sun Prairie, WI 53590 undertake. Each and every day, caregivers across Wisconsin wake up and prepare for a day where they put others
608.834.3400 before themselves. Perhaps there is no job as difficult and as fulfilling as caring for our seniors and ensuring
www.badgergraphics.com their health, wellbeing, and comfort. Seniors helped build our country. They raised families, transformed our
society, and shaped our communities. Meet some of the faces of long-term care here in Wisconsin who care for
For more information in advertising in our extraordinary residents.
Continuum call 608.257.0125 or go to

www.whcawical.org/continuum.
If you are planning on moving and
would wish to continue receiving
Continuum, call 608.257.0125 and
inform WHCA/WiCAL of your new
address.
2017 Badger Graphic Systems.
All rights reserved. The contents of this
publication may not be reproduced by
any means, in whole or in part, without
prior written consent of the publisher.
PUBLISHED MAY 2017
20
LTC LEGAL LETTER
Informed, Involved, and In Control: RoP changes to Residents Rights
With the dust having settled on efforts to address the most notable implementation aspects of Phase I of
the significant revisions to the federal nursing home Requirements of Participation, and before the Phase II
requirements begin November 2017, it is a good time to step back and assess and assure compliance with the
finer points of certain regulatory changes, including the residents rights section of the final rule.
22 CLINICAL CORNER
Person-Centered Care and the Importance of Effective Planning
Person-centered care is not a concept new to long term care, but it has become a focal point with the revised
CMS Requirements of Participation released last fall. The patient-centered model of care requires a cultural shift
from provider-knows-best to one in which staff fully recognize and respect each residents individual choices
and autonomy.

Spring 2017 | CONTINUUM 5

 Capitol Connection
State Budget Outlook and the Future of Medicaid
By Ramie Zelenkova and Katie White of Hubbard Wilson Zelenkova
STATE BUDGET
In his budget proposal, Governor Scott
Walker included a $51.5 million increase
for SNF Medicaid reimbursement. His
proposal did not include an increase in
funding for Family Care. Due to these
budget developments, WHCA/WiCAL
and other state provider associations have
issued revised joint budget requests:
SNF Budget Request. The
joint budget request for
skilled nursing reimbursement
indicates our support for the
governors proposal to increase
nursing home Medicaid rates by
2% annually totaling $51.5
million over the biennium to
support direct care workforce
and increased resident
acuity, and increase rates for
intermediate care facilities for
individuals with intellectual
disabilities (ICF-ID) by 1%
annually. Further, the request
indicates support for the
Governors proposal to increase
the behavioral and cognitive
impairment incentive (BEHCI)
funding by $5.0 million in
each year of the biennium.
Family Care Budget Request.
The joint Family Care budget
request asks the Legislature to
invest $40.4 million GPR in
the 2017-19 biennial budget to
fund increases for the direct care
and services component of the
Family Care capitation rates to
target critically needed increases
to address the long-term care
workforce crisis.
These budget requests were recommended
by the WHCA/WiCAL Payment Council,
reviewed by the Executive Committee,
6 CONTINUUM | www.whcawical.org
and approved unanimously by the
WHCA Board of Directors.
WHCA/WiCALs team of six lobbyists
will continue to work with key legislators
and other stakeholders to advance these
budget requests. Perhaps the most
effective advocacy resource the long-
term care profession has is YOU. We
encourage members to reach out to their
state legislators to offer the perspective
of Wisconsins long-term care providers
regarding the 2017-19 Biennial State
Budget. Thank you to all who attended
this years Caregiver Day at the Capitol
on March 28 and to all who have
participated in budget listening sessions
held around the state. Your voice is
critical as we work to impress upon
legislators the need to prioritize long-
term care in the State Budget! Please visit
www.whcawical.org/legislative for more
information on legislative outreach.
MEDICAID AND THE ACA
Whats in store for Medicaid and the
Affordable Care Act (ACA)? That is the
million-dollar question. How will changes
at the federal level impact the current
state budget process? A full and fast
repeal of the ACA fell short of the votes
WHCA/WiCAL members and other stakeholders met with DHS Secretary Linda Seemeyer
during Caregiver Day at the Capitol, WHCA/WiCALs Legislative Day, on March 28
needed to pass when House Republican
leadership unveiled The American
Health Care Act (AHCA) earlier this
year. Groups immediately lined up in
opposition to the AHCA including the
American Hospital Association, AARP,
the American Medical Association, and
even conservative groups such as Heritage
Action, American for Prosperity, and the
Cato Institute, which made it difficult
for the plan to gain any traction. The
Association of Health Insurance Plans
stopped short of opposing, but went
public with their misgivings about the
bill saying the plan created unnecessary
disruptions in coverage and cut Medicaid
funding too much. Republican Governors
also expressed concern with the plan.
The bill provided $10 billion for states
over five years that did not expand their
Medicaid programs, but leading health
care advocates in Wisconsin said our
state would not fare well under the plan
primarily because Medicaid funding
would be based on the number of people
in the state with income below 138
percent of the federal poverty level, not
on how many are covered in the program,
which means bigger states would receive
most of the money.
While the initial effort to repeal
and replace the ACA failed, House
GOP members recently passed an
amended version of the bill, although
the legislations future is unclear in a
skeptical Senate.
In the amended proposal, states would
program. However, there are major
Ramie Zelenkova is a
differences to consider between block
partner at the lobby
grants and per capita block grants. firm Hubbard Wilson
The House Republican plan conceded Zelenkova and represents
federal Medicaid financing to a per WHCA/WiCAL as a
capita cap beginning FY 2020. A per WHCA Lobbyist. She can
capita block grant program would ebb be reached at rzelenkova@
and flow with the economy while a flat hwz-gov.com.
Ramie Zelenkova has over a decade of experience in lobbying,

have two Medicaid financing options block grant would put Wisconsin moregrassroots advocacy and legislative research and has worked to
maintain strong relationships with legislative members on both

from which to choose. Under the first
option, as under the original bill, states
could receive a per capita cap allocation
amount for all Medicaid populations
at risk during a recession. Katie White is a contract
sides of the aisle. Ramie represents a variety of clients in areas
such as health care, long-term care, child welfare and education.
Ramies experience includes an extensive background
lobbyist with Hubbard
representing client interests before the Wisconsin Department of
Health Services, with particular experience representing Medicaid
Wilson Zelenkova and
managed care delivery interests. Some of Ramies recent
Wisconsin State Medicaid Director accomplishments include assisting in the development of the
represents WHCA/WiCAL
state's first medical home to support patient- centered
Michael Heifetz recently presented at coordinated care, obtaining Medicaid coverage for home-based
as a WiCAL Lobbyist.
mental health services for children, passing legislation to prohibit

(aged, blind/disabled, children, adults,
and other adult populations). Under
the second option, states would choose
to receive a block grant for children,
adults, and other adult populations.
However, the proposed block grant
amendment would not allow states to
receive a block grant for the aged or
blind/disabled populations, as these
groups would remain under the per
capita cap financing structure. The
amended bill also provides a higher
annual growth rate for the aged and
blind/disabled categories, from the
Consumer Price Index (CPI)-Medical
growth rate to CPI-Medical plus 1
percent. This change will result in
more funding than was included in the
original bill.
Insiders say GOP leadership estimates
they have until the end of May to
pass a health care reform bill. This is
primarily because parliamentary rules
would limit the majoritys authority to
approve a health care reform measure
using reconciliation once a new budget
is unveiled, which Republicans need if
they want to pass a tax reform package.
Without reconciliation as a tool, it would
take 60 votes, rather than 51, to pass a bill
in the Senate, which would be impossible
given the opposition from Democrats.
There continue to be unknowns and
critical issues regarding health care
reform, and in particular its impact
on state Medicaid programs. Governor
Walker has publicly announced his
support for both repeal of the ACA and
converting Medicaid into a block grant
a University of Wisconsin Population
Health Institute sponsored briefing on
the future of the ACA and Medicaid.
Director Heifetzs presentation included
the current overview of our Medicaid
program and associated cost pressures as
well as considerations for a block grant
program. The University of Wisconsin
Population Health Institute briefing
included many other informative
presentations. Members are encouraged
to view those presentations at www.
whcawical.org/uwphi. A summary of
The American Health Care Act from
the Kaiser Foundation can be viewed at
www.whcawical.org/kaiserahca.
How does all of this tie into the current
state budget process? Federal action on
the ACA and Medicaid will certainly
impact Wisconsin, but with so many
unknowns the Joint Committee on
Finance is proceeding under the
traditional process of agency briefings,
public hearing, and executive committee
meetings. The Legislative Fiscal Bureau
released its analysis of the Governors
budget recommendation and has started
to release individual budget papers.
Agency briefings were scheduled for the
end of March and six public hearings
were held across the state in April. The
Committee began its markup of the
budget bill on May 1. Once again, we
ask that members continue reaching out
to lawmakers and urge them to support
the Governors proposal to increase
nursing home reimbursement by $51.5
million and to add new funding for
direct care and services under the Family
Care program.
insurers from setting fees for dental procedures, and passing
She can be reached at
legislation to allow Family Care long-term care districts to be
licensed HMOs.
kwhite@hwz-gov.com.
Me
mb Excl
ers usiv
hip e
Be
ne
fits
Service Corporation
VISION We are a team of professional
and compassionate long-term
health care providers continuously
enhancing quality long-term health
care through education, advocacy,
relations, professional development,
innovation and partnership.
MISSION STATEMENT To advance the
quality, value and professionalism
of long-term care providers through
education to enhance quality long-
term care for the benefit of residents,
employees and the long-term care
provider community.
For more information
Contact WHCA/WiCAL:
131 West Wilson Street, Suite 1001A,
Madison, WI 53703 | 608.257.0125
Spring 2017 | CONTINUUM 7
 Media Matters

Optimize Your Online Presence:

Using Online Review Sites to Benefit Your Census
By Jim Stoa, WHCA/WiCAL Public Affairs Director

M ore and more each day, consumers

are relying on online reviews while
considering products or services. Online
retail giant Amazon boasts millions of
customer reviews. Popular sites like Yelp
and Trip Advisor have seen the power of
online reviews and have turned them into
revenue-generating machines. Online
reviews arent just abundant, they are
often expected by consumers. 92 percent
of consumers now read online reviews
prior to making a purchasing decision.
Studies of online reviews
have determined that a
positive review is nearly as
powerful as a promotional
sale or special offer.
Studies of online reviews have
determined that a positive review is
nearly as powerful as a promotional
sale or special offer. And some negative
reviews arent necessarily harmful 70
percent of consumers trust online reviews
more when there are some bad reviews as
well as good reviews, and 95 percent say
they will still buy a product that has bad
reviews. Why? Because consumers want
to spend their money wisely, and they
seek out authenticity in reviews.
to new dynamics, and long-term care
is no exception. Industries from
restaurants and hotels to golf courses
to nail salons are working to embrace
and grow within a new online review
reality. Instead of growing apprehensive
of online reviews, the long-term care
provider community must see them as
necessary for future growth and success.
Consider these statistics which show the
power of online reviews:
90 percent of people say
online reviews influence their
purchase decisions.
88 percent of people trust online
reviews from strangers as much
as personal recommendations.
40 percent of consumers form
an opinion by reading just one
to three reviews.
Quality comes first, second, and third
but we cant ignore online reviews.
We all know the critical importance of
the 5-Star Rating System, and WHCA/
WiCAL will continue to encourage
providers to participate in quality
advancement programs like last years
Strive for 5 program and the 1st Annual
Quality Symposium, to be held May 24 in
Stevens Point (find out more information
at www.whcawical.org/education). Our
commitment to quality has led to the
recent addition of WHCA/WiCAL
Director of Quality Advancement and
Regulatory Affairs, Jackie Strader.
WHCA/WiCAL also is active in recruiting
members to participate in the AHCA/
NCAL Quality Awards, which offers
facilities opportunities and resources for
growth and improvement. With quality
metrics always in mind, facilities should
also consider the benefit that small efforts
can have on increasing your online review
footprint. Optimizing your facilitys online
reviews will help families considering
your facility hear from current or former
residents and their family. These reviews
can help provide potential residents a more
personal insight into your facility.

Long-term care professionals may often

consider online reviews to be potential
business inhibitors. Thats largely
because consumers are often more likely
to be compelled to respond to a negative
experience than they are to a positive one,
and a stressful moment or experience
with a frail loved one may lead a family
member to leave a poor online review.
However, every profession must adapt

8 CONTINUUM | www.whcawical.org
Although there is a seemingly infinite
landscape for writing and reading
online reviews, there are a few websites
that dominate the web-review industry:
Yelp is one of the worlds largest
customer review sites that includes both
computer and mobile platforms. Yelp
has a monthly average of 25 million
unique visitors and over 115 million
written reviews. Yelp is free of cost to
use by business owners and is a necessary
platform for all businesses to be on.
Google is the largest global search engine
with more than 1.6 billion unique
monthly visitors. Google Reviews can
be seen and submitted by anyone who
searches your facility and is integrated into
Google Maps, a popular mapping service.
Reviews come up in a Google search, so
maintaining a positive reputation on
Google is an absolute necessity.
HealthGrove is a unique customer
review engine specifically for the medical
and health community. HealthGrove is a
site where users can search and compare
various skilled nursing and assisted living
facilities. HealthGrove is home to a wealth
of information for consumers, so having
a (good) reputation here is important.
Bottom line: having an online presence
is vital to engaging prospective residents
and their families and ensuring the future
success of your facility. If your facility
currently lacks an online review footprint,
dont worry! Increasing your online
presence and reviews is a simple process.
Here are WHCA/WiCALs tips to
improving both the quantity and quality
of your online reviews:
1. Make sure that you have a
company page.
You must first make sure that
your company has a page to
review. Search your facility on
the various online review sites
to see if you have an already
existing page or if you need
to make a new one. Online
review sites will often already
have generated a page for your
company, and all you need to
do is claim and verify your
page, which will allow you to
actively maintain it.
2. Make it easy to leave reviews.
One of the easiest ways to
increase the number of online
reviews is by making the
reviewing process as convenient
as possible for the reviewer.
Ask residents or their families
to leave a review, and give
them instructions to eliminate
confusion that could occur
otherwise. WHCA/WiCAL has
developed a template handout
facilities can provide to
residents with clear, simple
instructions (see the image
[to the right/to the left/etc].
If you would like an editable
version of this document, please
contact me jstoa@whcawical.org.
Customers are less likely to leave
a positive review if the process
for leaving one is difficult or
confusing. To avoid this, create
calls to action in newsletters and
provide links on your company
site to your specific review pages.
3. Actively maintain your pages.
The most successful companies
online are frequently also
the most active and well-
maintained. This includes
updating news and information
as changes arise, presenting
up-to-date pictures, and being
responsive to comments and
reviews. Of course, not every
review will be positive. One
rule to follow when responding
to negative feedback is the rule
of threes: while it is all right
to leave a polite response to a
negative review, if the original
reviewer responds again, stop
the exchange after the third
response. This prevents drawn
out conversations that could
have an even greater negative
impact than the original negative
review had on your facility.
4. Provide review-worthy care!
It may seem obvious, but the
most effective way to generate
positive reviews is by providing
customers with review-worthy
service. In general, most people
will submit a review if their
experience lands on one of
two spectrums: very positive
or very negative. Most wont
expend the energy to review a
company with which they had
an average experience. To have
more people submit positive
reviews, companies must
provide excellent all-around
service and display gratitude
to every customer for utilizing
their companys services.
WHCA/WiCAL is always looking
to help member facilities achieve the
success they deserve and desire. If you
have any additional questions or would
like more information regarding online
review site optimization, please contact
jstoa@whcawical.org.
Jim Stoa is the Public
Affairs Director for
WHCA/WiCAL. He
can be reached at
jstoa@whcawical.org.
Spring 2017 | CONTINUUM 9
 Stakeholder Spotlight

DHS Secretary Linda Seemeyer

Q&A
Linda Seemeyer was
appointed by Governor
Scott Walker as Secretary
of the Department of
Health Services (DHS)
in August 2016.
Secretary Seemeyer has
a long history of service
in state and county government. Prior
to being appointed as the Department
of Health Services Secretary, Seemeyer
was the Director of the Walworth
County Department of Health &
Human Services from 2007 to 2015.
Seemeyer also previously served as the
Director of the Milwaukee County
Department of Administrative Services,
and Deputy Secretary of the Wisconsin
Department of Administration under
Governor Tommy Thompson.
WHCA/WiCAL recently interviewed
Secretary Seemeyer regarding LTC
issues here in Wisconsin.
Prior to being appointed Secretary of
DHS, you served as the Director of the
Walworth County Department of Health
& Human Services, where you oversaw a
county-run nursing home. Can you tell us
more about your experience as a nursing
home superintendent and what you
learned in that role?
storm was in the forecast, and I found
myself in charge. Many staff members
and employees came in and stayed
overnight. I made sure they had breakfast
and ordered pizza, because I felt they
had gone above and beyond. After the
storm passed, a staff member thanked
me, but told me, Linda, this is what we
ALWAYS do. It opened my eyes to the
dedication of our nursing home staff to
the people in their care, as well as the
great responsibility that our nursing
home had to provide high-quality care,
regardless of the circumstances because
there were lives that were dependent on
our care. I also learned how important
a diversified payor mix is to a nursing
homes fiscal bottom line. Its like filling
an airplane you need a balance of first
class, economy, and discounted fares to
be successful.
You started serving the people of Wisconsin
as DHS Secretary in August 2016. What
do you enjoy most about your service? What
have been your biggest challenges so far?
I was deeply honored to receive the
appointment to DHS Secretary, and
I am very happy to be working with
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people of Wisconsin. I really like the
team that we have at DHS they are
very smart and incredibly dedicated to
the work that we do. I am fascinated with
business mechanics of Medicaid and
what it takes to operate this very large
insurance company. One of the biggest
challenges that Ive faced is that DHS is
an amazingly diverse organization with
a very large number of stakeholders
and partners who often have different
viewpoints and priorities. Sometimes it
can be a challenging balancing act. And
of course, one of our greatest challenges,
and opportunities, is the uncertainty of
what lies ahead of us at the federal level.
A serious LTC caregiver workforce crisis
has led to 1 in 7 CNA positions remaining
unfilled. How do you see the workforce
crisis affecting long-term care in Wisconsin?
It certainly is a serious problem. Today,
thanks to advances in medicine and a
greater concern about our individual
health, we Baby Boomers are living
longer. Our data shows that by 2040,
Continued on Pg. 16

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 Data Digest
PEAL: A Big Deal
By Kate Dickson, WHCA/WiCAL Director of Reimbursement Policy
PEAL
Performance Excellence in Assisted Living
H ow can your assisted living facility
use data to make informed decisions?
If you have detailed performance and
quality data at your disposal, your facility
is in a much better position to continually
achieve performance excellence. How this
information changes over time and how it
compares to other assisted living facilities
is a vital part of your internal quality
assurance and improvement journey.
What if I told you that as a member of
WiCAL, you can participate in a program
to aid you in gathering and monitoring
this data, all for free? WiCALs Performance
Excellence in Assisted Living (PEAL)
program is a voluntary quality improvement
program open to all WiCAL members,
regardless of their licensure or certification.
Participation is voluntary, but all members
are strongly encouraged to participate
currently, two-thirds of WiCAL members
are part of the PEAL program.
Participating facilities will be trained in
recognized performance excellence criteria
and quality improvement processes.
Specifically, the PEAL program will
rely heavily on the Baldrige 2011-2012
Healthcare Criteria for Performance
Excellence as the foundation of the
program. The Baldrige Criteria for
Performance Excellence (the Criteria)
provides a systems perspective for
understanding performance management.
It is accepted nationally and internationally
as the model for performance excellence
across business sectors.
WiCALs PEAL program offers
continuous education and training for
12 CONTINUUM | www.whcawical.org
participating Assisted Living facilities. organized to improve the outcomes of
Regular training topics include: individuals living in Wisconsin assisted
Development of an effective
quality improvement system
including the operation of
living facilities including Community
Based Residential Facilities (CBRF);
Residential Care Apartment Complexes
efficient quality committees. (RCAC) and Adult Family Homes
Foundational instruction on how
to conduct a proper committee
meeting to achieve efficient results.
(AFH). WCCEAL is an innovative
collaborative including Wisconsins
regulatory and public funding
Performance improvement processes: agencies (DHS); the Wisconsin state
Benchmarking data. ombudsmans program; the four
Identifying opportunities assisted living and residential provider
for improvement. associations and the Center for Health
Root cause analysis. Systems Research and Analysis (CHSRA).
PDSA cycles.
Monitoring data over time. Being part of the WCCEAL program will
include limited participation in some data
In addition, the PEAL program is hosting submission, as well as engaging in a common,
an impressive schedule of educational agreed-upon resident satisfaction assessment
webinars and in-person meetings as part of the monitoring and evaluation
throughout 2017 (see table below). process. Each community will collect and
report key indicators to a central repository.
PEAL participants are also automatically These indicators include:
part of the Wisconsin Coalition for
Demographics, including:
Collaborative Excellence in Assisted
client groups served;
Living (WCCEAL) program. WCCEAL
Continued on Pg. 24
is a group of dedicated stakeholders
WEBINARS WILL TAKE PLACE VIA THE ADOBE CONNECT SOFTWARE
PLATFORM FROM 1:00 PM - 2:00 PM ON THE FOLLOWING DATES:
MAY 11, 2017
QUALITY IMPROVEMENT PROCESS: OPERATIONALIZING YOUR QUALITY COMMITTEE
JUNE 8, 2017
RESIDENT SATISFACTION SURVEYS AND PUTTING DATA INTO ACTION
JULY 13, 2017
INTERACT INTRODUCTION
AUGUST 10, 2017
EFFECTIVE OUTBREAK PREVENTION AND RESPONSE
SEPTEMBER 14, 2017
EMERGENCY PLAN AND PROCEDURES FOR ASSISTED LIVING FACILITIES
OCTOBER 12, 2017
PUTTING THE ME IN MENUS
NOVEMBER 9, 2017
PART 1: PEAL 2017 RETROSPECTIVE
DECEMBER 14, 2017
PART 2: PEAL 2018 PROSPECTIVE
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 Cover Story

The Faces of Long-Term Care

Profiling the Heroes on the Front Line of Caring for Wisconsins
Most Vulnerable Residents
By Jim Stoa, WHCA/WiCAL Public Affairs Director

C aring for our most vulnerable

community members is perhaps
the greatest responsibility we as a society
undertake. Each and every day, caregivers
across Wisconsin wake up and prepare for a
day where they put others before themselves.
Perhaps there is no job as difficult and
as fulfilling as caring for our seniors
and ensuring their health, wellbeing,
and comfort. Seniors helped build our
country. They raised families, transformed
our society, and shaped our communities.
Its almost poetic that, after a lifetime of
contributions and growth, many seniors
turn to younger generations to provide
them the care they need.
One colleague recounted
a story when Jeanette
refused to miss work
resident. Its about health and wellness
through professional medical and
therapeutic systems, but long-term care
also requires warmth, attention, and a
deep and abiding respect.
Some people may consider the prospect
of caring for seniors a burden. Caregivers
see it as an honor. They are the unsung
heroes who dedicate their lives to caring
for others. And while they may not
expect recognition for their service, its
important to tell their stories.
SHINING EXAMPLES
Jeanette Garb, a CNA
at Fountain View
Care Center near
Ripon, embodies the
steadfast dedication
and unending positivity
found in caregivers at
facilities across our state.
Jeanette has been a fixture at Fountain
View Care Center since its founding
more than 50 years ago. Jeanette remains
as committed to her job today as she was
on her first day. She exemplifies the ideal
caregiver she always has an encouraging
demeanor, she is organized and is always
willing to lend a hand, and she has an
unwavering commitment to caring for
the residents at Fountain View.
One colleague recounted a story when
Jeanette refused to miss work during a
heavy Wisconsin snowstorm. Instead,
she had a colleague pick her up so she
wouldnt miss her shift serving the
residents at Fountain View.
Garbs commitment is clear as
she discusses her close and caring
relationship with residents.

during a heavy Wisconsin

snowstorm. Instead, she
had a colleague pick her
up so she wouldnt miss her
shift serving the residents
at Fountain View.

For only being four letters, care is a

complex word. In a health setting, care
often relates to the act of administering
medicine, and helping to improve
patient or resident health. And thats
certainly a significant aspect of long-
term care. But frontline caregivers take
care to a deeper level: residents often
become a part of their daily life and
identity. They care for the resident,
but just as much, they care about the

14 CONTINUUM | www.whcawical.org
The best part of my day is just coming
to work, Garb said. I love my job, and
I just love our residents. I always have.
Like so many dedicated frontline
caregivers throughout the state, Garb
often goes the extra mile, willing to come
in on her days off, to care for residents.
To me, theyre like family, Garb said
of the residents at Fountain View. This
is how I would want my mom and dad
or grandma and grandpa taken care of.
It is no surprise that Garb has
dedicated her career to caregiving. Her
coworkers consider her the most caring,
dependable, and thoughtful person at
Fountain View. She makes work easier
for her co-workers and makes life better
for all the residents she cares for.
For her unwavering commitment,
dedication to her work, her residents,
and coworkers at Fountain View Care
Center, WHCA/WiCAL presented
Garb with the 2016 Shining Star Direct
Caregiver award at the 65th Annual Fall
Convention in Green Bay last October.
All facilities have a Jeanette Garb who
emanates love and caring to residents,
their families, and other staff members.
Care Center when she was 20 years old
in 1975. Throughout her 41 years as a
cook at Plum City Care Center, Hartung
has seen many changes to her kitchen
and mentored countless coworkers. And
while change may be constant, Hartungs
commitment to providing good, healthy
meals to residents has always remained
her top priority.
When asked her favorite part of her
job, Hartung was quick to praise the
Visit www.whcawical.org/shiningstar
residents she serves every day:
for information on how to nominate
a deserving staff member for a
The best part of my job is how nice the
2017 Shining Star Award at the
residents are, Hartung said. Everyone
66th Annual Fall Convention, held
sure appreciates me!
November 2. Deadline for the
Shining Star application is October 6.
Hartung helps create a true sense of
community at Plum City Care Center
And care goes beyond by making herself approachable and
direct caregiving. Take available not just to residents, but to staff
Ruth Hartung, a cook as well. Nursing staff are comfortable
at Plum City Care asking her to make something special
Center and 2016 for residents who may prefer a different
Shining Star support meal or may not be too hungry. Hartung
staff award winner, who grew up in Plum City and understands
goes to painstaking the value that the care center offers
efforts to accommodate the entire community. Her passion
individual resident dietary preferences for serving her care community and
and needs. Hartung started at Plum City the entire city demonstrates Hartungs
caring commitment to her work. And
her commitment to service is reflected
in the quality of life of residents at Plum
City Care Center.
In fact, care facilities often serve as a pillar of
a community. Care centers become homes
for the seniors who built and shaped our
communities, and it is comforting to know
that there is a place in our community for
our frail elderly residents when they and
their families determine they need some
extra help or care.
The sense of community
at long-term care
centers is often
sustained by local
community members
who lend their time
and efforts to make life
better for residents. For
Continued on Pg. 18
Spring 2017 | CONTINUUM 15
 Stakeholder Spotlight Continued
the states population of people ages
65 and older will increase 72%. That
means more and more people will
need some type of individualized care,
either in a nursing home, assisted living
facility, or in their own home.
The Department has worked closely with
WHCA/WiCAL and other provider
associations to address the workforce
crisis. What are some ways the provider
community and the department can work
collaboratively to address this crisis?
Our goal is to develop a planned approach
to begin addressing the workforce crisis.
We look forward to continuing our work
with WHCA/WiCAL and other provider
associations to explore creative ideas to meet
the needs of the growing population of
elders who require caregiver services whether
it is in a nursing home, assisted living
Regardless of what
reform may bring,
maintaining our high
quality, community-
based care remains one of
my priorities.
center, or in their own homes. We are also
looking forward to reviewing and moving
forward with some of the recommendations
identified by the Wisconsin Long Term
Care Advisory Council.
How do you think the Trump
administration will reshape Medicaid,
and how will those changes affect long-
term care providers serving frail elderly
and disabled citizens?
There are currently many moving
parts and it is unclear how the Trump
Administration will approach reshaping
Medicaid. Discussion in Washington is
centered on a block grant structure and
new financial mechanisms for serving
Medicaid members. We are working hard
to ensure that the Trump Administration
and Congress understand Wisconsins
16 CONTINUUM | www.whcawical.org
success in achieving 100% access to
health care coverage for our residents
living in poverty, and the successes we
have achieved with our stakeholders to
serve many of our elderly and disabled
members in the community rather than
in institutional settings. Regardless of
what reform may bring, maintaining
our high quality, community-based care
remains one of my priorities.
How do you expect the finalized budget to
affect long-term care providers?
As youre aware, Governor Walkers
2017-2019 Biennial budget calls for
nursing home rate increases of more
than $50 million over the next two years.
This money will go to support direct
care staff in nursing homes and to reflect
the increasing acuity of nursing home
residents. Governor Walker has also
proposed a personal care provider rate
increase of nearly $15 million to support
direct care staff and to reflect the increasing
acuity of individuals receiving personal
care services. These recommendations
show that the Governor recognizes that
Wisconsin has a caregiver workforce crisis
that needs to be addressed.
Given the disparity in the issuance of high
severity deficiencies in Wisconsin nursing
facilities when compared to other states, is
DHS examining its processes to determine
if they are applying different standards
than their counterparts in other states?
The federal Centers for Medicare and
Medicaid Services (CMS) is aware of the
current disparities between Wisconsin
survey findings and the survey findings
in some other states in our region.
However, CMS has not informed the
DHS Division of Quality Assurance
(DQA) that Wisconsin is not following
federal survey protocols and directives.
In fact, DQA consistently scores well
on federal State Performance Standards,
which is the rating system that CMS
uses to determine if states are correctly
following federal survey protocol. CMS
surveyors conduct this review throughout
the year and observe state survey teams
in nursing homes that are conducting
surveys and complaint investigations
and making compliance decisions. CMS
surveyors determine if the state surveyors
are properly identifying deficient practice,
implementing federal standards as
specified by CMS, and using enforcement
actions to ensure continued compliance.
DQA is currently reviewing the federal
survey protocol and directives to determine
if there is any flexibility granted to state
agencies in issuing violations of federal
regulations and the choice of enforcement
remedies. We are also examining the use
of optional remedies that are less punitive
for certain violations to determine if they
would achieve the same level of sustained
compliance without being financially
burdensome.
Do you see an opportunity for Wisconsin to
seek an alternative survey and enforcement
process, one that builds upon identified
successes of collaborative efforts rather than
the current punitive approach to enforcement?
DHS is ready and willing to work
collaboratively with nursing home
representatives and resident advocates
to develop and pilot a modified nursing
homes surveyprocess that is similar to
modified survey that was proposed in
2002. This modified process will tailor
the length and depth of the survey
to the individual facility and focus
more resources on facilities that are
experiencing more significant problems
than their peers. Some facilities would
experience no change in the current
survey process while other facilities will
experience a more intensive survey,
depending upon the facility history and
problems identified during the initial
phase of the survey. This will allow DQA
to assist noncompliant facilities to come
into compliance, ultimately improving
care through the provision of limited
technical assistance and the sharing of
best practices guidelines. This proposal
would allow Wisconsin the flexibility
needed to improve the quality of care
and quality of life for vulnerable nursing
home residents to a greater extent than
we are presently able to do.
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 Cover Story Continued
example, Verna Theil of Weyauwega
at 96 years young volunteers at
Crossroads Care Center of Weyauwega
regularly. Theil who won the 2016
Shining Star Volunteer award helps
lead recreational activities at the center
helping with large group activities one
or two times each week. Theil often
will arrive early to scheduled activities
to visit with residents and assist them
to the activity. Staff all agree that
Vernas efforts help residents reach
their potential and encourage them to
remain active in activities. After all, shes
participating, and shes often older than
the residents are!
For administrative
personnel, clinical
workers, caregivers, and
support staff, the common
denominator is care in its
many iterations.
Verna is very humble when she delivers
service to the residents here, said Tim
Dietzen, administrator at Crossroads
Care Center of Weyauwega. She makes
them feel like a million bucks.
18 CONTINUUM | www.whcawical.org
Theil has even brought other volunteers
with her to help during activities. She
has created connections with several
residents and helps build a strong sense
of community at Crossroads, impacting
residents lives in such a positive way.
We all associate health care delivery
as the critical and essential aspect of
care. But its important to remember
that as important as delivery of needed
health services is the personal, familial
connections made by personnel like
Garb, Hartung, and Theil.
Administrators like Joe
Simonich of Avanti
Health Systems
2016 Shining Star
Administrator award
winner are eager to
take on the noble and
imperative responsibility
of creating a person-
centered care plan for residents. Care
providers tasked with ensuring the delivery
of health services along with creating
and maintaining a warm, engaging
atmosphere for residents rely on staff
at every level to meet residents varying
needs. For administrative personnel,
clinical workers, caregivers, and support
staff, the common denominator is care in
its many iterations.
GROWING TO MEET THE NEEDS OF
LONG-TERM CARE RESIDENTS
Across the country, 10,000 baby boomers
turn 65 every day. The Wisconsin
Department of Administration projects
that our states over-85 population will
increase 140 percent between 2010 and
2040. As the baby boomer generation
continues to age, providers know that
the demand for long-term care is going
to increase in the coming years.
But the challenge lies not just in increased
demand. With a new generation of
long-term care residents come new
expectations and demands that the
long-term care provider community
will have to adapt to. Along with new
federal regulations aimed to alter how
care is delivered to residents, these
new generational changes will require
providers to reevaluate current practices.
Providers are already preparing and
making changes with an understanding
that change will be constant.
EMERGING LEADERS TO CREATE NEW
FACES OF LTC LEADERSHIP
With a new generation
of residents comes
a new generation of
administrators and
long-term care leaders.
Wisconsin is fortunate
to be home to the UW-
Eau Claire Health Care
Administration program
and the Center for
Health Administration
and Aging Services
Excellence (CHAASE).
This premier health
care administrator
degree program which
prepares graduates to be
effective and innovative
administrators.
Because of the UW-
Eau Claire HCAD
program and CHAASE
and an expectation of
excellence in Wisconsin
Continued on Pg. 26
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Spring 2017 | CONTINUUM 19

 LTC Legal Letter

Informed, Involved, and In Control:

RoP changes to Residents Rights
By Brian Purtell, WHCA/WiCAL Legal Services Director

W ith the dust having settled on

efforts to address the most
notable implementation aspects of
Phase I of the significant revisions to
the federal nursing home Requirements
of Participation, and before the Phase
II requirements begin November 2017,
it is probably a good time to step back
and assess and assure compliance with
the finer points of certain regulatory
changes, including the residents rights
section of the final rule. While certainly
there is little to suspect that the provider
community is not diligent in respecting
and promoting the rights of residents, it
is important to appreciate the changes
found in Section 483.10, as several
additions and modifications have been
made to this important section. With
nearly all of the subsections, there are
multiple and varying clarifications or
additional facility expectations, thus
careful review of this entire section is
warranted to assure policies, procedures
and processes to address all.
afford important resident input, it should
also be reflected in policy, procedures,
and practices to be able to demonstrate
explicit involvement expectations.
In furtherance of compliance efforts,
facilities should review their current
practices to assure they are reflective
of the revised expectations. While not
exhaustive, the following identify some
key elements of the new regulations that
should be reviewed carefully:
483.10(c) Rights to planning and
implementing care: While prior
regulations regarding the care planning
process included expectations of resident
and/or representative involvement,
additions within this subsection
certainly create more prescriptive
expectations that warrant review to
assure facility practices are consistent
with the stated rights. Keys aspects
include the heightened expectations of
residents right to be informed and to
participate in the person-centered care
planning process; specific reference to
inclusion regarding residents strengths
and needs, as well as incorporating
the residents personal and cultural
preferences in developing goals of care.
Consider reviewing your facilitys
initial and ongoing assessment and care
planning processes to identify how,
where, and when residents rights in this
area are both stated and documented.
482.10(f ) Self-determination: The
most notable modifications within
this subsection relate to residents
right to immediate access by certain
individuals and agencies and specific
requirements related to the facility

Most of the expectations within 483.10

are not entirely new, however additions to
the prior version and the addition of some
provisions that were previously elsewhere
in the rules require careful review to
assure compliance. The broader shift
and emphasis of the person-centered
concept and expectations, which place
the focus on the resident as the locus of
control, is notably woven within the rights
section. This is particularly evident in the
sections regarding rights to planning and
implementing care, 483.10(c) and self-
determination, 483.10(f). Within these
and other sections, the resident input
and participation expectations represent
a subtle but important shift in the
regulatory dictates. While most facilities
will be confident that their processes
20 CONTINUUM | www.whcawical.org
written policy requirements regarding
visitation rights of residents. Review
and modification of such policies and
procedures compared to the explicit
content requirements and obligations
to inform should be considered. Rights
and opportunities to participate in
resident or family groups, and a facilitys
procedure for receiving and responding
to recommendations from such groups,
should also be reviewed against current
facility practices to assure compliance.
Also notable within this section are
the provisions that retain that specially
prepared or alternative food requested
instead of food and meals generally
prepared remain under items and
services that may be charged to
residents funds. This provision is
qualified by reference to the new dietary
section which requires a facility to
take into consideration the residents
needs and preferences and to consider
the overall cultural and religious
make-up of the facilitys population.
Therefore, review of processes for menu
development should be considered to
assure compliance with both the dietary
requirements and the residents rights.
483.10(f) Information and Communication:
Notable changes include updating
communications to reflect internet/
email; required notices, including right
to receive in a format and language
resident understands (including Braille);
and availability of survey information
for the past 3 years. While facilities do
not have to post 3 years of survey results,
language indicates the information
must be available for any individual
to review upon request along with a
posting of notice as to availability.
483.10(j) Grievances: While the
prior right to voice grievances without
discrimination or reprisal remains, this
section adds significant procedural
expectations. Most significant is the
establishment of a grievance policy
to ensure prompt resolution of all
grievances. The section details required
policy provisions, including posting
requirements; the identification of a
facility Grievance Official responsible
for overseeing the process; written
response/decision requirements; and
3-year retention of grievance decisions.
Certainly, the issuance of Guidance to
Surveyors, expected later this summer,
will impact facility expectations in
the area of residents rights, however,
attention and action regarding the
updated content of 483.10 should not
wait until the Guidances are issued.
Brian Purtell is the
Director of Legal
Services for WHCA/
WiCAL and the
Executive Director of
WiCAL. He can be
reached at bpurtell@
whcawical.org.

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Spring 2017 | CONTINUUM 21

 Clinical Corner

Person-Centered Care and the Importance

of Effective Planning
By Deb Martin, RN, BSN

P erson-centered care is not a concept

new to long-term care, but it has
become a focal point with the revised
the change to person-centered care?
The idea is that when staff truly get to
know each resident and their family
Benefits to the residents include:
Residents are in a close
relationship with staff that are
Centers for Medicare and Medicaid members care decisions are then based attuned to their changes and
Services (CMS) Requirements of on the individuals need and wants can respond appropriately.
Participation (RoP) released last rather than what is best for the facility Residents continue to live in a
fall. Phase I, which went into effect and staff. The goal is that the individual way that is meaningful to them.
November 28, 2016, includes the resident is not only at the center of their For example, under this type of
requirement that facilities implement care planning and decision-making but plan, residents also have more
comprehensive, person-centered that care plans change and evolve as the freedom and control over their
planning as a necessary component of individuals needs change. schedules, including when they
providing quality care to residents. sleep and when and what they eat.
The National Nursing Home Quality
The Final Rule published October 4, 2016, Improvement Campaign (NNHQIC) Benefits to nursing home staff include:
defined person-centered care in this way: has outlined the goals and benefits of Staff members are more
person-centered care. comfortable caring for people
For purposes of this subpart, person- they know.
centered care means to focus on the Staff know a persons preferences,
resident as the locus of control and support can anticipate the persons needs
the resident in making their own choices and adapt accordingly.
and having control over their daily lives.
The patient-centered model of care
requires a cultural shift from provider-
knows-best to one in which staff fully
recognize and respect each residents
individual choices and autonomy. A
new generation of residents want those
choices: that is what they have had at
home and what they want when they
come to a facility. Staffing shortages can
be a challenge in facilities that operate
under a traditional model of care.
Proponents of the change say person-
centered care more fully engages the
resident and their family. It requires a
cultural shift from a practitioner-knows-
best model of care to a plan that promotes
each residents choices and control over
their health care and daily lives. Care
plans become a collaboration between
staff, the resident, and their family.

GOALS OF PERSON-CENTERED CARE

The first question you may have is Why

22 CONTINUUM | www.whcawical.org
Benefits to the nursing home include:
Nursing homes have better
quality outcomes due to the
ability of staff to identify
and respond appropriately to
changes in a residents condition.
Nursing homes have better staff
retention due to a strong relationship
between staff and residents
Comprehensive Person-Centered
Care Planning (483.21)
Admission: 48 Hours to Create a
Baseline Care Plan
CMS has updated the requirements
around care planning upon admission.
Facilities used to have up to 14 days
to develop a comprehensive care plan.
Under the new CMS requirements,
facilities must develop a baseline care plan
for each resident within 48 hours of their
admission with care instructions that
include, at a minimum, the following:
initial goals based on admission orders;
physician orders;
dietary orders;
therapy services;
social services;
and a pre-admission screening
and resident review (PASARR)
recommendation, if applicable.
Every person who is admitted to
your facility comes with distinctive
challenges, needs, and goals. To be in
line with what makes their situation
unique, communication and planning
are key. That initial assessment tells staff
what their preferences are rather than
waiting 14 days to learn about their
preferences. This eases the transition to
living in the facility. It is important to
include family in discussions to gain a
comprehensive overview of the person
entering your facility. The facility is
required to provide the resident and
their representative with a summary of
the baseline care plan.
Alternatively, in lieu of developing
a baseline care plan, the facility may
develop a comprehensive care plan within
48 hours of the residents admission.
COMPREHENSIVE CARE PLAN
Within seven days of completing
a comprehensive assessment of a
new resident, you must develop a
comprehensive care plan. The plan
must include any specialized services
or specialized rehabilitation services the
nursing facility will provide as a result of
Pre-admission Screening and Resident
Review (PASARR) recommendations.
A nurse aide and a member of the food
and nutrition services team must be on
the interdisciplinary team that develops
the plan.
DISCHARGE PLANNING BEGINS UPON
ADMISSION
Discuss the residents discharge
plan upon admission. Develop and
implement a patient-centered discharge
planning process focused on resident
discharge goals, and increasing resident
participation in implementing and
succeeding with those goals.
Per CMS requirements, the discharge
planning process must also:
ensure the residents discharge
needs are identified and result
in the development of an
individual discharge plan;
include regular re-evaluation to
identify changes necessitating
modification of the discharge
plan;
involve the interdisciplinary
care team in developing the
discharge plan;
consider caregiver support
person availability and
capability to perform the
residents required needs;
involve the resident and
resident representative in the
development of the discharge
plan, and inform the resident
and resident representative of
the final plan;
address the residents care goals
and treatment preferences;
document that a resident has been
asked about his or her interest in
receiving information regarding
returning to the community;
for residents who are transferred
to another SNF or who are
discharged to an HHA, IRF,
or LTCH, the facility must
assist the resident and his or
her representative in selecting a
post-acute care provider; and
produce a timely document,
including in the residents
clinical record, the evaluation
of the residents discharge needs
and plan. The results of the
discharge planning must also be
discussed with the resident and
the residents representative.
Future care plan revisions are
meant to support the residents
involvement and control as well
as resident satisfaction and safety.
STAFF BUY-IN
Patient-centered care is a mindset that
front-line staff must embrace for it to
work. It is a completely different model of
care, from staffing numbers to job duties
of the staff. No longer can everything be
done on a regimented schedule because
the goal is to provide residents with
choices. Instead, everyone must figure
out how to balance the demands of each
resident and get everything done.
Even before CMS mandated the
policy change, many facilities had
already begun moving to a household
model, constructing smaller units with
dedicated staffing trained to provide a
broader range of care to residents. For
those with a traditional facility model,
moving to a person-centered model of
care will take more creativity and staff
involvement to implement the model
into your facility.
Deb Martin RN,
BSN is an Account
Executive for CE
Solutions. Deb started
out her nursing career
in the NICU. She also
was a Sales Account
Executive with a
leading pharmaceutical company and
a Director of Nursing at a Skilled
Nursing Facility for 10 years.
Spring 2017 | CONTINUUM 23
 Data Digest Continued
occupancy;
staff size;
RN Access;and
staff retention.
Quality improvement
structure, including:
quality improvement activities;
infection control; and
staff immunization.
Quality improvement process
including:
receiving input;
improving satisfaction;and
communication.
Quality improvement
outcomes, including:
falls;
infections; and
hospital readmissions.
WCCEAL members are required to submit
these quality improvement variables on
a quarterly basis. The Center for Health
Systems Research and Analysis (CHSRA),
at UW-Madison will process this data.
Individual community data will not be
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24 CONTINUUM | www.whcawical.org
shared with the Wisconsin Department
of Health Services or with other
communities. But you will have access
to important comparison reports related
to these quality improvement variables as
well as to the yearly resident satisfaction
survey - the ability to both tangibly
measure improvement and satisfaction
in the various areas of operations, and to
compare facility performance against other
participating facilities, is a tremendous
performance improvement tool.
The WCCEAL program is gaining national
attention and is expected to continue to gain
significance, having received a substantial
grant award to further the project from the
Wisconsin Partnership Program, designed
to support and extend innovative health
projects.This grant awarded the WCCEAL
program $1 million from 2016-2021.
When assisted living communities and
health care facilities implement internal
quality assurance and quality improvement
throughout their systems, they achieve
better outcomes for their residents, and
WHCA/WiCAL and its PEAL Program
will continue to make pursuit of these
efforts a priority, said Brian Purtell,
WiCALs Executive Director.
If you are interested in more information
about the PEAL program or considering
participation, WHCA/WiCAL staff would
be happy to answer any questions that you
may have. You can reach WiCAL Executive
Director Brian Purtell at bpurtell@
whcawical.org or WHCA/WiCAL Director
of Quality Advancement and Regulatory
Affairs Jackie Strader at jackie@whcawical.
org. As always, do not hesitate to call
WHCA/WiCAL offices at (608) 257-0125.
Kate Dickson is
the Director of
Reimbursement Policy
for WHCA/WiCAL.
She can be reached at
kate@whcawical.org.
 Care Classic
July 17, 2017 | The Oaks, Cottage Grove
SAVE THE DATES

A fun-filled event where camaraderie takes A WHCA/WiCAL tradition of 39 years.

precedence over competition. Raising more than $125,000 in scholarship money.
Non-golfers are encouraged and welcomed.

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November 1-3, 2017 | Radisson, Green Bay
Offers attendees premier educational programming. Fall Convention Gold Business Partner showcase.
Networking opportunities. Programming that keeps you at the forefront of the
Recreation and fellowship. long-term care provider profession.

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Spring 2017 | CONTINUUM 25

 Cover Story Continued
long-term care, Wisconsin has a wealth
of young, energetic administrators eager
to become leaders in long-term care.
WHCA/WiCAL is working to foster a
new generation of leadership, working
with new leaders including Steve Kuranz
of Oak Ridge Care Center, Mike Jones of
ManorCare Health Services-Pewaukee,
and Spencer Beard of Wellhaven Senior
Housing to create a new Emerging Leaders
professional development program.
The Emerging Leaders program will be a
year-long program open to about a dozen
enrollees each year. The program will
include a regular educational component,
professional development and networking
opportunities, and association committee
participation. Interested individuals
from member facilities can expect more
information on the finalized program
ahead of Fall Convention.
Change in long-term care is a given.
But the long-term care profession will
continue to adapt as new leaders emerge
and guide the provider community.
Look for updates and enrollment
opportunities at www.whcawical.
org/emergingleaders.
A NEW FACE AT WHCA/WICAL
Long-term care providers are committed to
providing quality care. WHCA/WiCAL,
like its member facilities, strives to adapt
and grow to meet new challenges. As
26 CONTINUUM | www.whcawical.org
quality measures have taken center stage
for regulators and others along the post-
acute care continuum, your association
will continue to emphasize quality. Our
assisted living division, WiCAL, has
developed a robust and comprehensive
quality program through its Performance
Excellence in Assisted Living (PEAL)
program (for more information, see this
issues Data Digest article on page 12).
On May 24, WHCA/WiCAL will hold
its first annual Quality Symposium,
which will offer a critical opportunity
for collaborative learning, worthwhile
breakout sessions, panel discussions, and
a keynote address from Theresa Lang of
Specialized Medical Services, Inc.
WHCA/WiCAL Quality Symposium.
May 24. Find out more at www.
whcawical.org/education.
To ensure we continue
to meet members
Quality needs, WHCA/
WiCAL is excited to
welcome new Director
of Quality Advancement
and Regulatory Affairs,
Jackie Strader.
Strader has 27 years of experience as a
Registered Nurse. Her experience includes
serving as District Director of Clinical
Operations for Kindred Healthcare,
Regional Director of Operations, and
Regional Director of Clinical Operations for
SunBridge Healthcare, and most recently,
as Chief Clinical Officer for Exceptional
Living Centers. Strader graduated from
Bellarmine University with a Bachelor
of Science degree in Nursing. She is the
former Deputy Executive Director/State
Long Term Care Ombudsman for the
State of Kentucky. In this role, she oversaw
operations, daily complaint management,
and resident health and safety compliance
for Kentuckys 120 counties. Strader
was also instrumental in recommending
changes in law and regulations pertaining
to the health, safety, welfare, and rights of
long term care residents.
Strader started out in health care as a nursing
assistant. She understands the regulatory
environment and the importance of
legislative affairs and its impact on skilled
nursing and assisted living facilities. Strader
will work with staff from member facilities
to ensure their voices are heard and assist
them in development of resources.
Building relationships with member
facilities and stakeholders is a priority as
I begin this new position, said Strader. It
is a privilege and an honor to represent
some of the greatest people who care
for those who are unable to care for
themselves.
CONTACT JACKIE. Members can reach
Jackie Strader at (608) 257-0125 or
via email at jackie@whcawical.org.
While the challenges facing long-
term care are many, there are no
obstacles that cannot be overcome by
the determination and commitment
of long-term care professionals across
our state. As we face new regulations,
a challenging reimbursement climate,
and new expectations and demands,
one thing is clear: our strength is our
people. Together, there is no challenge
too great.
Jim Stoa is the Public
Affairs Director for
WHCA/WiCAL. He
can be reached at
jstoa@whcawical.org.
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Wisconsin Health Care Association Wisconsin Center for Assisted Living

131 W. Wilson Street, Suite #1001

Madison, WI 53703

REGISTER TODAY!
The Wisconsin Health Care Association will be offering timely and innovative professional development programs in the
areas of SNF Medicaid Reimbursement, Quality Advancement, Requirements of Participation, and the Survey Process.

The First Annual Requirements Overcoming New

Quality Symposium of Participation: Survey Challenges
Program Approval # 20180523-6-EJVS-IN Prepare & Succeed Program Approval #20180926-4-VEHV-IN
Stevens Point | May 24, 2017 | 8:00am Eau Claire | Sept 27, 2017 | 8:15am
Program Approval #20180718-4-NTHJ-IN
Eau Claire | July 19, 2017 | 8:15am Appleton | Sept 28, 2017 | 8:15am
WHCA/WiCAL is pleased to announce its Brookfield | Sept 29, 2017 | 8:15am
first annual Quality Symposium. This event will Appleton | July 20, 2017 | 8:15am
offer a critical opportunity for collaborative Brookfield | July 21, 2017 | 8:15am
The new year will again bring new survey
learning, worthwhile breakout sessions, and challenges. This workshop will help you
a special guest presentation by Dr. Robert This workshop will help centers prepare
to make necessary changes to comply meet these challenges and equip you with
Smith, President of the Wisconsin Society for the tools to demonstrate compliance with
Post-Acute and Long-Term Care Medicine. with the new Requirements of Participation
(RoP) that will be enforced in three phases current and impending expectations.

Presenters Include (starting Nov. 28, 2016, Nov. 2017

and Nov. 2019). This workshop will Presenters Include
Pat Virnig, RN Brian Purtell, Esq
Director, Bureau of Nursing Home Resident include a mix of instructive presentations
and multiple interactive exercises using Legal Services Director
Care, DHS Division of Quality Assurance WHCA/WiCAL
material brought by attendees from
Dr. Robert Smith, MD, CMD their center to help centers start to make
President, Wisconsin Society for Post-Acute changes they need to comply with
and Long-Term Care Medicine RoP Phases I and II. The session will
also include significant time for group
Jackie Strader, RN, BSN, CDP, discussion and a review of available
Directory of Quality Advancement and resources and tools.
Regulatory Affairs, WHCA/WiCAL
Presented By
Lyn Bentley
Catherine Schueller, RN, BSN, RAC-CT
Vice President of Quality &
Vice President of Clinical Operations &
Regulatory Affairs
Reimbursement, Exceptional Living Centers
American Health Care Association
Sue LaGrange, RN, BSN, NHA, CDONA,
FACDONA, CIMT Jackie Strader
Director of Education, Pathway Health Director of Quality Advancement &
Regulatory Affairs
Theresa Lang, RN, BSN, WCC WHCA/WiCAL
Vice President of Clinical Consulting
Specialized Medical Services, Inc.

go to www.whcawical.org to register
Please call George W. (Skitch) MacKenzie, NHA at skitch@whcawical.org
or call (608) 257-0125 for further information.