Pulse June/July 2006 - FHCA

A Long Term Care Monitor of Nursing Home and Assisted Living IssuesPulse

JUNE/JULY 2006

PRSRT STDU.S. Postage

PAIDTallahassee, FLPermit No. 1007

Florida Health Care AssociationP.O. Box 1459Tallahassee, FL32302-1459

InsideA Day in the Life of an NHA.. . . . . . . . . . 8CMS Sit-Down .. . . . . . . . . . . . . . . . . . . . . . . . . 12Dining Forum .. . . . . . . . . . . . . . . . . . . . . . . . . . 20LTC Business News . . . . . . . . . . . . . . . . . . . . 26

FHCAFLORIDA HEALTH CARE ASSOCIATION

Update

Sylvester is‘future leader’

FHCA Senior VicePresident David

Sylvester is one of only 21 people in thenation selected to

participate in the American HealthCare Association’s 2006-07 FutureLeaders of LTC in America symposiumJuly 17-18th in Washington, DC.Future Leaders is a twelve-monthtraining program that familiarizesparticipants with key long term careissues and helps them develop betterleadership skills.

Levine, Francoisconfirmed

Agency for Health Care Admin-istration Sec.Alan Levine was

confirmed by the Florida Senate duringthe last week of the 60-day 2006 legislativesession.The vote allows

Levine to remain at AHCA until atleast 2007, when Gov. Jeb Bush leaves

office.Also confirmed wasDepartment of HealthSec. Dr. Rony Francois,who was appointed inSeptember 2005.

Mega Pulse

In addition to a complete update on important legislative, regulatory,

quality improvement and reimburse-ment issues, this month’s super-sized32-page FHCA Pulse also containsvaluable information about goodsand services on display at the FHCA–FCAL 2006 Annual Conferencetrade show. The regular monthlyproduction schedule resumes withthe August 2006 issue.

Real Royalty:Thelma Ardery, right, was among many who chatted and posed for pictures with Miss USA 2005, Chelsea Cooley, during a recent lunchtime visit to The Haven of Our Lady of Peace in Pensacola.Below right, Alma Bell of Sandy RidgeCare Center in Milton was crownedMs. Northwest Florida Senior duringthe sixth annual FHCA District XII (Pensacola) Ms. Northwest FloridaSenior Pageant. For more, see “Newsfrom Across Florida,” page 23.

In a sudden and unexpected move described as“baffling” by FHCA Executive Director BillPhelan, on May 25th Gov. Jeb Bush vetoed

some $91 million in Medicaid nursing homefunding, including $65.5 million targeted at those

facilities that had been most seriously impacted by previouscuts. The governor also cancelled the restoration of $25.6 million in funding cut last year.The vetoes dealt serious blows to the financial stability of the state’s 700 nursing homes.

“By cutting our lifeblood, Governor Bush has dealt a blowto the steady improvement in quality of care we have seen since

A Treasured Elder:Still Punching Strong

See Page 10

The elegant Gaylord PalmsResort & Spa in Kissimmee

is the site for the FHCA-FCAL2006 Annual Conference, thelargest event of its kind in Florida. This year’s theme is “The New Age of Old Age…Let the Revolution Begin!”

FHCA members and otherattendees will be able to choosefrom 41 continuing educationseminars with the potential for 24contact hours in both nursinghome- and ALF-specific topics.Full registrants will also receivefour free correspondence coursesin HIV, End-of-Life/PalliativeCare, Medical Errors and DomesticViolence, a $125 value.

CONTINUED ON PAGE 5

CONTINUED ON PAGE 3

Bush-whacked:$91 million in nursing home funding vetoedCuts threaten quality improvementand financial stability; access tonursing homes imperiled2006

FHCA-FCALAnnual Conference

headed to Kissimmee

Dynamic keynoters; huge trade show;

24 hours of CE; Rainplays at finale banquet

What was he thinking? I simply can’t fathom Governor Bush eliminating $91 million in criticalnursing home funding, which was about 20 percent of the total $449 million he line-item vetoed.

A St. Petersburg Times editorial stated the governor says he “hunts down legislators” pet projects, partic-ularly those that don’t serve a statewide purpose or are not vetted by a government agency, and stripsthem from the budget on principle. By what standard, then, does he veto the elderly in nursing homes?

It might have been different were our state in dire financial straits, but this year there was a surplusof at least four and as much as six billion dollars.The governor said this surplus was for a “rainy day.”Governor, I hesitate to say this so directly, but in the lives of the elders for whom we care, a hard rainis falling down right now and you just took away their umbrella.

Florida’s nursing homes should never be expected to continue to take these funding hits. In axingthe Medicaid funding we had so diligently worked to obtain in the Senate and House, Gov. Bush threatens the very quality improvements he had long championed. I believe his vetoes will also put at riskhis own plans for Medicaid managed long term care. So, until we all can work together in developinga new program, our society has the moral obligation to preserve the current Medicaid program as asafety net for those who truly need it. FHCA and its allies will not shy away from this basic, funda-mental public policy objective and social responsibility.

This will be one of the greatest challenges for our next FHCA President.Which brings me, howeverindirectly, to my next point.

Memorable momentsAs I conclude my term as FHCA President, I note that several people have asked me what my most

memorable moment was. There have been several, but the most memorable were the hurricanes of 2004 and 2005. This is what really tests your mettle. We again showed what we were made of and whywe are the pride of our profession.

My most memorable trip (and there were many trips) was in March 2005, when my wife Cathy andI, FHCA Senior Vice President David Sylvester and Executive Director Bill Phelan visited the WhiteHouse.We ate breakfast in the West Wing in what FHCA lobbyist Bob Asztalos calls the “Navy Mess.”Our host was Director of the White House Office of Faith-Based and Community Initiatives JimTowey, the former legal counsel to Mother Teresa and the brother of FHCA media/public relationsconsultant Ed Towey. Later, we all were seated in the front row at a White House event at whichPresident Bush himself spoke and greeted us.

Thank youI am greatly encouraged to see the slate of FHCA officers for next year. Member talent and com-

mitment is a wonderful thing, something we’ve always been fortunate to enjoy and benefit fromthroughout FHCA’s 52-year existence. History, leadership and strong roots are what have kept ustogether, and I must personally thank FHCA past presidents Bobby Rosenthal (1998-2000) and TomKelly (1994-96) for their constant support.Thanks also to all our associate members who came throughduring the hurricanes and continue with strong commitment in service. I have always had a greatrespect and appreciation for our dedicated staff at FHCA, but having worked even closer with each ofthem over the past two years makes you understand even more why we are the envy of all the stateorganizations. Bill, Cathy, Dawn, Debbie, Erica, Judi, Kelli, Koko, Lee Ann, LuMarie, Peggy, Rita,Susan,Teresa,Tony,Venetia — you are the All-Star team.

A personal thank-youI must also thank our partners at Allied Mobile X-Ray, Eric and Aaron, for their generous support

of me and FHCA.You always hear about the bad partnerships, well, I am blessed. Okay, how blessed amI? Anyone who really knows me knows my wife. You also know her constant support, understandingand shared commitment to FHCA and caring for and Treasuring Our Elders.Without her support Icould not have run for this office. Her belief in me strengthens me everyday. Saying “thank you” to mywife Cathy is not enough and saying that I am a blessed man would be an understatement. The Beatlessong “Here,There and Everywhere” opens with this line: To lead a better life I need my love to be here.Know me, know my wife. Know our Annual Conference chair.

Never can say goodbyeAnd in the spirit of our 2006 FHCA-FCAL Annual Conference theme,“The New Age of Old Age...

Let the Revolution Begin,” I say (and I quote the Beatles one more time)You say goodbye and I say hello.I can’t wait to see you and say hello to you at conference.

It is unity — not necessarily unanimity — that is important for us to write the future.One mission. One voice.

Florida Health CareAssociationDion Sena,

President

Bill Phelan,Executive Director

David Sylvester,Senior Vice President

Deborah Franklin,Secretary

Nina Willingham, Treasurer

FHCA PulseJUNE/JULY 2006

FHCA Pulse is produced monthly for theFlorida Health Care Association, P.O. Box1459, Tallahassee, FL 32302-1459, by EdTowey & Associates, Inc.

Editorial – To submit information, guestarticles, press releases, etc., contact EdTowey at (850) 224-6242 or via e-mail [email protected]. Fax information to (850) 224-9823 and include your name,telephone number and e-mail address. To contact FHCA, call (850) 224-3907.

Advertising – For information on Pulse ad-vertising rates and availabilities, contact IanCordes at Corecare Associates at (561) 659-5581 or via e-mail at [email protected].

All articles and advertising are subject toeditorial review.

FROM thePRESIDENT’S

DESK

by Dion SenaFHCA President

Our next FHCAPresident will have a great challenge

FHCA JUNE/JULY 2006 Pulse2

Am-Bushed by ‘Veto Corleone’

FHCA JUNE/JULY 2006 Pulse 3

ImpressiveLine-Up:

Left to right,keynotespeaker U.S.Navy Capt.J. Charles

Plumb, Retired, will discuss overcomingadversity in his talk, “Who Packs YourParachute?”; second-day keynoter PatrickBrannelly’s topic is “Breakthroughs inBrain Science: Transforming the Way WeAge”; Beatles tribute band Rain entertainsat the annual banquet, the highlight ofthis year’s conference.

2006 FHCA-FCAL Annual Conference headed to KissimmeeCONTINUED FROM PAGE 1

“We always want to combine equalamounts of education and fun,” FHCAAnnual Conference Committee chair CathySena said.“This is our chance to get togeth-er and support one another.”

HighlightsIn addition to two outstanding keynote

speakers, the 2006 FHCA Nursing HomeAdministrator of the Year will be named, alongwith other awards that recognize outstand-ing legislators, members, volunteers, individ-ual patients and residents, associate membersand those who excel in community out-reach activities. FHCA’s highest honor, theWalter M. Johnson, Jr. Circle of ExcellenceAward, will also be given at the end of theannual banquet. The Circle of Excellencerecipient is chosen by previous years’ hon-orees and nobody, including the honoreehim or herself, knows who the winner isuntil it is announced by FHCA SecretaryDeborah Franklin, the 2005 honoree.

A 275-booth trade show will feature thelatest and best goods and services available to long term care professionals, and at the

two general membership sessions, candidatesfor FHCA office will be elected to serveone-year terms, changes in bylaws will bevoted on and a set of officers for the newly-reconstituted Florida Center for AssistedLiving will be elected.

Event organizers chose a 1960s-era “new

age” theme, so “flower power” and hippieimagery from the era will be omnipresent,particularly at the trade show. “It will bereminiscent of Woodstock. Come preparedto let your mind wander — only with allnew cutting-edge information on aging andlong term care delivery systems,” Sena said.


With the government denying moreand more Medicaid applicants after

they have already been admitted to longterm care facilities, providers have beensearching for means to collect for servicesrendered. This problem is not unique toFlorida. In fact, it is a universal issue, giventhe limited ability to transfer or discharge apatient for non-payment.

Legal standingA facility in Tennessee recently took an

interesting approach, with great results. InBeverly Healthcare Brandywood v. Gammon, thecourt overturned a transfer of property infavor of a provider.The first hurdle that thefacility had to overcome was the ability tomaintain the action, legally prove standing.In Gammon the court held that the facilityhad standing under the Tennessee fraudulenttransfer statute. Florida has a similar statute,found in Chapter 726, Florida Statutes. Thisstatute allows a creditor to sue for a fraudu-lent conveyance.You may be that creditor.

Next, the court looked at the facts under-lying the transfer of the patient’s assets.In Gammon, the patient was admitted to the facility on February 28, 1997. He was

approved for Medicaid in April of that year.He had less than $2,000 in assets, except for his residence. Since he indicated anintent to return to his house, it was treatedas an exempt asset.

Fraudulent conveyanceHis daughter, Betty Gammon, was the

man’s agent under a durable power of attor-ney. Purportedly, on advice of counsel, shesold her father’s house and distributedapproximately half of the proceeds to herselfand her two sisters. In addition, she paid$5,000 to herself and her sisters for a service-for-life agreement. Some money was left inthe father’s account. He was disqualified forMedicaid for several months. He apparentlydid not pay the nursing home the privatepay rate for those months.

The lower court held that the sisters’wereliable to the nursing home for the debt,because under Tennessee statutes in effect atthat time, the patient had knowledge that his future debts would exceed his ability to

pay. Since he had no life-threatening illness,he reasonably would expect to stay in thenursing home for a period of time. Sellinghis home gave him a non-exempt asset (theproceeds) from which to pay the nursinghome. He did not use the money to pay the nursing home, but rather transferred it to his daughters.The appellate court upheldthe lower court’s decision.

I cannot tell from the opinion that I read,whether the man personally was involved in the transactions or whether only hisdaughter, under the power of attorney hehad granted her, made the sale and con-veyance of the proceeds to herself and hersisters. However, I do not believe that thecourt decided based upon the actions of the daughter, since the judgment impactedall three sisters.

Florida lawFlorida has a fraudulent conveyances

statute similar to that of Tennessee. Underthe Florida statute, the creditor need nothold a debt when the property is transferred.The creditor’s claim can arise after the transferwas made if the potential debtor actuallyintended to defraud the creditor, was aboutto engage in a business transaction for whichthe remaining assets of the debtor were toosmall to satisfy the debt when it became dueor if the debtor should reasonably believethat he would have debts beyond his abilityto pay. Given a specific set of facts, any oneof these conditions might apply in a nursinghome lawsuit for payment for services.

While actual intent is often hard to prove, Chapter 726.105, F.S., sets out certainfactors which the courts may consider,absent specific evidence of intent. Theseinclude, among other factors, that the personwho received the asset was an insider, thatthe transfer was of substantially all of thedebtor’s assets, or that the transfer occurredshortly before the debt was incurred.

CaveatIn preparing this article, I have not done

extensive research on case law in Floridaunder this statute. However, in light of thereasoning in the Tennessee case, your attor-ney may want to take a look at the statuteand how our courts have interpreted it.Thismay be a fresh approach to collections or itmay be time for our courts to take a newapproach. Perhaps there is light at the end of the tunnel, if you have the right facts.

LTC LEGAL ISSUES and TRENDS by Karen Goldsmith

Goldsmith, Grout& LewisFHCA Legal Consultant

A collections case inTennessee might help you

Light at the end of the tunnel?


approval of his landmark SB 1202 elder carelegislation in 2001,” Phelan said on the dayof the veto.“We are extremely disappointedin him.”

If only…Had Gov.Bush not vetoed the $91 million

in funding, the 2006 legislative session mighthave been considered one of FHCA’s best in recent memory:

■ Major nursing home funding increaseswere approved with broad support in boththe Senate and House

■ The law protecting the confidentialityof facility adverse incident reports wasextended

■ Funding was restored for the Medicaidadult dental, hearing and vision program,including funding for partial dentures

■ A moratorium on new nursing homebed construction was extended for anotherfive years, with certain exceptions to allowfor local need

■ The alternative fee a leased facility mustpay in lieu of obtaining a lease bond washalved, from two to one percent of threemonths-worth of Medicaid payments

■ Minimum CNA staffing was increasedto 2.9 hours per patient per day, but it willbe measured on a weekly, not daily, basisand it will take effect January 1, 2007

■ Florida Senior Care, the Medicaid managed care program for the elderly, mustreceive final legislative approval beforebeginning the pilot programs scheduled for Orlando-Melbourne and Pensacola

■ The state’s Nursing Home Guide wasstreamlined to include more current WatchList information, and the combined reportwill be issued quarterly, not yearly

■ Some $17.6 million in funding wasapproved for construction of Florida’s sixthveteran’s nursing home

“Our disappointment is compounded bythe fact that state law requires us to provide(nursing) services, but the state won’t pay us for them,” Phelan pointed out.“This willlikely cause nursing homes everywhere toshift the cost to their private-pay patients,in effect imposing a ‘silent tax’ on them.Nursing homes will also be forced to care-fully limit their Medicaid-paid admissions,which will profoundly affect access to nurs-ing home care by middle-class familieseverywhere in the state.”

Phelan noted that nursing homes wouldhave used some of the additional funding to offset their losses due to greatly increasedfuel, utility and property/casualty insurancecosts.

“The governor is right to shoot downbudget ‘turkeys,’ but this is money that goesto pay for the care of Florida’s most frail citizens,” Phelan said.

Call to actionIn response to Gov. Bush’s veto, FHCA

sent letters to all Senate and House mem-bers thanking them for their support duringthe 2006 session and asking them to contacttheir respective leadership to urge restora-tion of the funding “through whatevermeans possible.” FHCA members are alsobeing encouraged to contact their state legislators to urge them to do likewise.

“We fought very hard for this funding,”Phelan said. “We’ll fight very hard to get it back.”

(Editor’s note: For more on the legislative session, see “LTC Business News,” page 26.)

Bush-whacked: $91 million in nursing home funding vetoedCONTINUED FROM PAGE 1

FHCA WelcomesNew Members

)

FCAL-NCAL MEMBERSBishop Grady Villas, St. CloudCrown Pointe of Spring HillThe Pavilion at Bayview, St. Augustine

ASSOCIATE MEMBERSAtlantic Healthcare, MiamiCareerStaff Unlimited, ClearwaterCommunity Education, LLC,

San Marcos, CADruzak Medical, Inc., Aliquippa, PAJames F. Gilroy III, P.A., TallahasseeMedicom, LLC, Brooklyn, NYRehab Care, Winter HavenResurgence Holdings, Inc., TampaSouthern Healthcare Assurance Group,

OrlandoStatewide Disaster Restoration,

Southfield, MI

Last month, assisted living facilities aroundthe state received a package of proposed

new rules from the Department of ElderAffairs.The rules have been developed inter-nally over the last couple of years betweenDOEA and the Agency for Health CareAdministration, the primary regulator ofALFs. Facilities are now getting a look at theproposed rules for the first time and are con-sidering whether or not the changes reflecta step toward improved service for theirclients or toward a more expensive andrestrictive health care model.

The Florida Center for Assisted Livinghas conducted a regulatory analysis of theproposed new rules and provided a detailedreport to members in mid-May.The changesinclude additional communication, docu-mentation, and organizational requirements,including:

■ Fire: A copy of the annual fire safety andsanitation inspections conducted by the

state’s local authority are to be sent by thefacility to AHCA within 30 days of theinspection; provides for new administrativeactions for failure to comply

■ DNRO: A statement of the facility’s pol-icy regarding Do Not Resuscitate Orders beincluded in the admission packet

■ Activities: An increase in scheduledactivities from five to six days and from tenhours per week to 12 hours per week

■ Contact: Facilities would be required tocontact a resident’s health care providerwhen observable health care changes occurthat may be due to the person’s medications.Documentation would follow in the resi-dent’s record

Proposals would increasecommunication, documen-tation and organizational

requirements

More new rules on theway for ALFs?

Florida Center for Assisted Livingby Lee Ann GriffinFHCA POLICY & QUALITYASSURANCE SPECIALIST

■ Documentation: Any communication afacility makes to report a resident’s unusualreactions or significant changes to the resi-dent’s health care provider would have to bedocumented in the client’s record

■ Rx labeling: New labeling and packag-ing requirements for customized residentmedication packaging

■ Rx packaging: New labeling and pack-aging requirements for sample or compli-mentary prescription drugs dispensed forthe resident

■ Keys: Facilities would be required tomaintain master or duplicate keys for theresident’s bedrooms and bathrooms

■ CLSP: ALFs with a Mental HealthServices license would now be required toinclude a description of other services theyprovide or can arrange as part of the resi-dent’s Community Living Support Plan

■ Moratorium: When notifying an ALFthat a moratorium is being placed on thefacility, the AHCA Area Office would haveto notify the ALF both in writing and via atelephone call on the same day. Currently,only a telephone call is required

Forms updatedAdditionally, some commonly used forms

for ALFs are being updated. For example,some changes to the Form 1823,“ResidentHealth Assessment for Assisted LivingFacilities,” are being proposed. First, theform is now produced by AHCA, notDOEA. Second, additional information willbe asked for regarding the resident’s abilityto perform self-care tasks and their need foroversight.

We have requested a rule hearing withDOEA to open these proposals up for dis-cussion.We will continue to work with ourassisted living facility members to bring anyconcerns forward at that time.


F H C A

Web siteWeb site• NEWS, BULLETINS• MEMBERSHIP• REGULATORY• REIMBURSEMENT

www.fhca.org


(Editor’s note: John Simmons is FHCADistrict IX (Jacksonville) President and theadministrator of 163-bed Jacksonville Nursing & Rehab Center. As a health care administratorwith more than 30 years experience, he will conduct a seminar, “Proud Again to be anAdministrator,” during the FHCA – FCAL2006 Annual Conference. Simmons writes,“I’velearned that having a positive attitude is crucial.Keeping it is the tough part!”)

Monday, 7:20 a.m. Arrived at work andwas soon met in the parking lot by two ofmy best CNAs who complained they neverhave enough linen to do their rounds prop-erly — that laundry never brings themenough. Promised them I would look intoit. Stopped at laundry department on theway to my office. Laundry lady says some ofthe CNAs take the linen and hide it in thepatients’ rooms. She says the aides want torun out of linen so that they do not have towork. Hmmm. Promised to look into it.

7:35 Started my morning rounds. Thehallway circulation fan is off again. For threeyears I have had to turn it on every morn-ing to circulate the air. No one ever seems to know who turns it off or why after I leave the night before. Three years! Some-

day I am going to find this “no one” and ask why he/she does that!

7:50 Check several rooms and find a tonof linen stacked in the closets. The linen isclean, but I toss it into the soiled-laundrybarrel to wash it again.Will talk to night staffone more time. Maybe it’s time for a 2:00a.m.“raid” and some write-ups!

8:30 Check e-mail from corporate.Another conference call for tomorrow.

9:00 Morning meeting. I rememberwhen these were “stand-up” meetings andended quickly. Business office claims nursingdepartment not turning in slips for billing in timely manner. Nursing claims they wereturned in on time but someone lost them.Wonder if “someone”is related to “no one?”

10:00 Medicare RUG meeting. Mustcheck all Medicare patients to make suretheir RUG level is appropriate.

10:30 Family member in to ask “why inthe hell” we cannot find Mom’s sweater.Try to explain that Mom wanders the facil-ity all day and thinks all the rooms are her

room. She is often found lying on anotherperson’s bed and often has removed variousarticles of clothing, so the sweater could beanywhere. (In fact, I’ll bet “no one” gave itto “someone” and they put it “someplace”out of the way.) Family member forcefullyexplains that Mom would never go into aroom not her own and that I do not reallyknow my own patients. Promise I will lookinto it. Invite family member to come in for a care plan meeting sometime since shehas missed the last three or four. Familymember explains she simply does not havethe time for that.

11:00 Fire alarm goes off. Maintenanceman said he forgot to tell me he was havinga drill today. Good news: all the staff knewwhat to do and did it well. Make a note tocome watch the next one on 11-7 shift tosee if they do as well.

11:35 Nursing agency salesperson comesin to give me candy and asks for more business. I tell him yet one more time thathe gets no business from me if he continuesto poach my staff for his agency. Candy isgood, however.

12:05 p.m. Rehab manager comes in to ask for more money for PRN staff.Seems rehab folks want to find yet anotherentrance into Ft. Knox! Should have gone to PT school.

12:25 Open mail from attorney’s officeasking for another medical record to be sentto their office because it seems we are nottreating his client well. The patient’s familymember has shown up from North Carolinato check on dear old Dad (the first time wehave heard from him in three years), and ofcourse, his second stop while in town was to dear old lawyer’s office. Spend 30 minuteslooking at medical record and thanking God for nurses who know how to docu-ment well.

1:15 Check kitchen and grab lunch.Found dirty can opener. Gave lecture aboutfood safety and that we must do everythingright all the time.

1:30 A family member stops by to thankus for doing a good job. That was nice.But there was a “however.” Seems Mom’shearing aid is missing. Aha! When I was in

The daily ups and downs ofhealth care’s toughest job

by John SimmonsA day in the life of anursing home administrator

Thoughts from the inside…

CONTINUED ON PAGE 13

7:00 a.m. Supervise Rusty’s Tree Service topping of two large trees overhangingthe parking lot

What’s NEWat MED-PASS/Heaton Resources?

Phone 800-438-8884 www.med-pass.com Fax 800-230-8687 www.heaton.org

Infection Control Policy & Procedure Manual

Preview this manual, designed to help establish infection control programs thatmeet the specific needs of the elderly population and the facilities caring for them.

Heaton Resources Policies & Procedures Online

Learn more about our full line of Policy and Procedure Manuals andRegulatory Guides in addition to individual policies, procedures and job descriptions now available for purchase online.

SmartStaff™ In-Service Training Programs

Over 40 titles in an easy-to-implement format that makes staff training simple and inexpensive.

Reference Resources For Your Special Needs

The recently updated Geriatric Medication Handbook is now available as well as new additions to the Clinical Reference Card Series.

Use this form to report any changes in a resident's condition.Describe the change in condition below and forward a copy of thisform to the community □ Wellness Director □ Director of Nursing

□ ________________________________

□ Accident, fall or incident□ Deterioration in mental status (confusion, delirium, etc.)□ Chest pain or other pain that is unusual for the resident□ Abnormal vital signs□ Persistent vomiting or diarrhea□ Choking incident or any new onset of respiratory problems□ Weight variance (change of 5% or more during last seven

days)□ Change in continence□ Unusual bleeding or bruising□ Skin deterioration (decubitus ulcer, significant skin tear,

rash, etc.)□ Changes in gait (stumbling, shuffling, balance problems,

etc.)□ Increased assistance needed in ____________________□ Other _________________________________________□ Other _________________________________________

Additional Comments: ________________________________________________________________________________

Rm/Regarding: _______________________ Apt. # ________

(Resident Name)

□ Witnessed □ told by the resident□ Noticed □ told by another individual

(specify: ______________________)

AMPMOn _____/_____/_____ at _____:_____

The following was

Employee Signature/Title Date

_______________________________________________________

White - Appropriate Director Yellow - Resident Record

For

m #

AL

10

20

Rev

. 2

/05

INH

1011

01R

eord

er F

rom

:80

0-43

8-88

84�

CARE ALERT

© C

opyr

ight

200

1 M

ED

-PA

SS

, IN

C.

All

right

s re

serv

ed

Documentation

A full line of Long-Term Care and ALF-specific documentation solutions,including forms for assessing, monitoring and risk management, are available for immediate use.

Booth# 128 Visit to see these new products.


A treasured elder...William David BesmanoffFormer heavyweight prizefighter still going the distance

Tough Guy:Besmanoff’s scrapbook docu-ments an exciting career andstirs many memories; at right,Besmanoff pounds Argentinianfighter Alex Miteff during a 1958fight in Seattle;Besmanoff’s solidupper body,lightning left andkeep-coming-at-you style madehim a fearsomeand formidableopponent.

Willie Besmanoff busily studies scrap-books jammed with newspaper clips,

photos and souvenirs of when he was one ofthe top heavyweight fighters in the world.

“I was a boxer, not a fighter,” Besmanoffquickly points out to the Treasure OurElders interviewer.True, and in his 73 years,he was also a professional baker, small busi-nessman, construction worker, civic booster,husband, father and grandfather. Today helives comfortably at the spacious MoultrieCreek Nursing & Rehab Center in St.Augustine, his home for the past six years.A heart condition and recurring balanceproblems have slowed him only slightly, andat 210 lbs., he is but five pounds above hisold fighting weight. His shoulders remainbroad, his fists massive, his eyes piercing andhis smile, ready and gentle.

Between 1952 and 1967, Besmanoffboxed in 92 professional matches against suchpugilistic legends as Zora Folley, ArchieMoore, Sonny Liston, George Chuvalo andin 1961, 19-year-old Cassius Clay fighting in only his tenth professional bout. Clay(three years later he changed his name toMuhammad Ali) won by TKO in the sev-enth, sending Besmanoff to the canvas twicein that round. “I was knocked down, butnever knocked out,” Besmanoff says withgreat pride of all his fights, including 62amateur contests before he turned pro.

German-AmericanBesmanoff was born the older of two

children to a German mother and Jewish-American father, a physician, in Munich,Germany in 1932. The couple divorcedbefore Besmanoff was eight years old. Hisfather returned to the U.S. as World War IIbroke out in Europe, and Besmanoff ’smother moved the family to Berlin to livewith her parents. His maternal grandfatherwas a prominent businessman and tranporta-tion executive who raised young Willie as his own son and looked out for the familyduring the extremely difficult war years.

Besmanoff vividly recalls the constantAllied bombing raids late in the war, one ofwhich caused the partial collapse of hisschool while he and his classmates wereinside. Trapped for almost two weeks,Besmanoff was rescued by his grandfather

who had organized a digging party to helpget them out.“I remember sitting down onwhat I thought was a log, but it was a badlyburned, dead body.”

Budding boxerBoxing for Besmanoff began after the

war, when at age 13, he joined an athleticclub organized by American GIs in occu-pied Berlin. Within four years he was itsundisputed champ and became somethingof a hometown celebrity. By early 1952,Besmanoff held the German lightweighttitle and was named to the first WestGerman Olympics boxing team eventhough, technically, he was considered anAmerican.

While still a teenager, Besmanoff wasapproached by managers and trainers whourged him to turn pro, which he did onAugust 15, 1952, against Hans Schreiber.Besmanoff lost in the fourth round, butwould fight 14 bouts after that before seeing

his second loss. His American debut cameFebruary 25, 1957, at the famous St.Nicholas Arena in New York City. The half-German half-American was an instantcrowd favorite, as much for his charisma as his impressive 34-5-7 record at that point.It was while he was in America thatBesmanoff ’s manager, Lou Burston,arranged a reunion between Besmanoff andhis estranged father whom he had not seen or heard from in 16 years.“He told mehe wanted my mother back, but she said she wouldn’t leave Germany. That was it.”

On the roadBesmanoff relocated to Milwaukee,

Wisconsin — a city with a large German-American population — and spent the nextten years touring the U.S., fighting seven or more times a year and building a namefor himself. He fought with great intensityinside the ring, but carried no personal animosity toward any of his opponents


outside the ring. He stayed in touch withmany of them over the years, includingMuhammad Ali.

Flipping through his scrapbook somemore, Besmanoff pauses at a yellowed newspaper clip from 1960, describing the“American Heavyweight Title” fightbetween Besmanoff and Archie Moore.“There’s ‘Old Baggy Pants,’” Besmanoff says, pointing to a photo of Moore. “Wewent at it for ten rounds in Indianapolisuntil he hit me right square on the nose andI started bleeding pretty bad. I think I wouldhave bled to death if the referee hadn’tstopped the fight.” Besmanoff boasts of having never sustained any serious injury inover 150 fights and never seriously injuringany boxer. “I was lucky. I was very lucky.”

Bowing outBy the late 1960s, the ring losses started

to outnumber the wins, and at age 34,Besmanoff sensed it was time to call it a career and return to being a full-timebaker, a trade he learned while a young manin Germany.He used his boxing winnings toopen a bakery in Melbourne Beach, andlater, another in nearby Satellite Beach.Still another newspaper clipping (OncePunching for Dough, Now Punching theDough) described how people loved to

come to the famous ex-prizefighter’s bakeryfor a loaf of his signature bread and to hearsome great boxing stories. Besmanoff laterwent to work for Publix and moved hisfamily from city to city in Florida as hehelped get their in-store bakeries up andrunning. Eventually, he settled down in St.Augustine, where two of his three daughterslive with their families.

Fond memoriesWas he ever scared in the ring?

Besmanoff insists he never was, even whenthings were not going well for him.Moultrie Creek administrator Brian

Ferguson agrees and recalls locating a SportsIllustrated video of one of Besmanoff ’s oldfights and sitting down with him to watch it. “He lost that particular fight, but he wasfearless all the way through.” Ferguson saysat the end of the fight the two sat in silenceuntil Besmanoff turned to him and said,“I remember every one of those punches.Some of them hurt a lot. But I feel goodnow and it’s great to have memories to share with everyone. I’ve had a good life.I’m a very lucky man.”

FHCA honors William David Besmanoffand treasures his many contributions to ourstate and nation.

Nice Guy:Besmanoff towersover his then four-year-old daughterBarbara in a pre-fight photo takencirca 1964. Atright, Dad anddaughter today.


The Centers for Medicare & MedicaidServices Region IV SNF Provider

Forum was held in Atlanta over two days lastmonth, with eight southeastern states’ healthcare associations represented, includingFlorida’s. CMS’ agenda began with a Medi-care Part D discussion and its impact onnursing home patients. One of the majorproblems has been with some long termcare pharmacies not contracting with someplans that had automatic enrollment of dualeligibles. The ability of dual eligibles tochange their enrollment on a monthly basiswas viewed as a protection for them.

Performance goalsThe CMS performance goals include the

decrease in the prevalence of restraints andpressure ulcers in nursing homes. CMSnoted pressure ulcers can be prevented withmost patients; that there are enhancedenforcement guidelines for surveyors; thatreduction remains a high priority; and thatconsumers view high pressure ulcer rates asindicative of poor quality of care.

Florida is reporting only a “very slightdecrease” from 9.7 percent in 2003 to 9.5percent in 2006, with the national averagebeing 8.5 percent. CMS’ target goal is toreduce the rate by a least one percent in2006.

RestraintsCMS further stated that many providers

still “mistakenly hold that restraints are necessary to prevent injury and they cancause incontinence, pressure ulcers, loss ofmobility and other morbidities.” Again,

personal computer throughout the survey torecord findings. The computer synthesizesand organizes the information for the surveyoutcomes. The intent of the revised surveyprocess is to improve “consistency and accuracy of quality of care and quality of life problem identification using a morestructured process” and to “focus surveyresources on facilities with the largest number of quality concerns.”

IJsThe long term care enforcement discus-

sion focused on Immediate Jeopardy situa-tions. There has been an increase in the IJfindings across the states.The regional officeimposes a civil monetary penalty of between$3,050 and $10,000 per day of ImmediateJeopardy or a per-instance CMP may beimposed for one or more deficiencies identified during a survey, not exceeding$10,000. CMS sends a public notice to the newspaper near the facility when an IJ is noticed. In all IJ cases, the provider agreement must be terminated by CMS no later than 23 calendar days from the lastday of the survey, if the IJ is not removed.Immediate Jeopardy removal is based on the following:

■ The scope of the problem: How manybeneficiaries, staff involved and outcome ofthe situation

■ A reasonable, feasible and comprehen-sive plan of removal

■ Evidence that the plan is being imple-mented

According to CMS, the basics in avoidingan Immediate Jeopardy citation are:

■ Assess patients for risk upon admissionand ongoing

■ Have a system in place to prevent accidents and incidents

■ The system in place must be effective in solving the problem identified

■ Continuous training and education ofstaff regarding the system and policies andprocedures at the facility

Pay-for-performanceNursing home quality followed with a

discussion of Congress’ pay-for-perform-

Florida has reported only a “slight decrease”in restraint use, down from 9.3 percent to9.0 percent since 2003, with the nationalaverage being 6.4 percent.Alabama leads theregion with a 3.4 percent restraint use and7.3 percent pressure ulcer prevalence rate.Some of the reported lessons learnedthrough the interventions of the QualityImprovement Organizations across thesouth included:

■ Extensive education has to be given to patients, families and staff

■ There are time constraints for moni-toring care

■ MDS coding confusion needs to beaddressed

■ More activities are needed forAlzheimer’s patients and those with relateddementias

■ Ongoing motivation of staff needs to be recognized

QI pilotThe CMS Quality Indicator Survey pilot

program is being demonstrated in five stateswith the plan to roll it out to 25 states in thenext year before national implementation.The QIS is a revised long term care surveyprocess with an initial review of larger samples of patients based on the MDS,observations, interviews and medical recordreviews.The QIS team members use a tablet

Part D plans, restraints,pressure ulcers, other topics on the agenda

by LuMarie Polivka-WestFHCA QUALITY CREDENTIALINGFOUNDATION SENIORDIRECTOR

CMS outlines goals during an8-state regional sit-down



A day in the life of a nursing home administratorCONTINUED FROM PAGE 8

the kitchen they found one left on a tray and I just happened to have brought it to my office with my lunch. Man, do I looklike a genius today. Once in a while I getone right.

2:00 Talk with hospital discharge planner.Family members do not want one of ourpatients to return to us, saying they have aproblem with how we care for her (thoughthey’ve never said anything to me). I wonderaloud with the DP if it might have some-thing to do with the fact that they are notfollowing through with the Medicaid appli-cation because they want Mom’s check topay the mortgage on Mom’s house wherethey also just happen to be living. Okay, Isay, tell them politely that we do not wanther back either. I am told “we can’t do that.”Either way, I can’t win.

2:40 Staff development person comes into remind me that I have to meet with theorientation class in five minutes and talkabout HIPAA and corporate compliance.

2:45 Meet new employees. All of themhave worked at other facilities. I ask if they

have heard of HIPAA. No one has. How can that be? After my lecture I check thefiles on the new recruits. I decide to call twofacilities and see if they will tell me morethan just their dates of hire, etc. Nope! But the administrator tells me to “watch outfor that one,” whatever that means.

3:15 Review latest survey material thatthe department heads gather monthly.Overall satisfaction is still running in thehigh 90 percent, which makes me feel bet-ter. Many of the comments are so positivethat I start to feel better about the day.After all, that’s why I am in this profession.

3:35 Vendor calls. Seems corporate didnot send them a check. Promise to look intoit. Call corporate and they claim we did notsend the invoice in a timely manner. Checkwith the department head involved whoclaims he gave it to AR in plenty of time.Check with AR and she claims she did it on time. Call corporate person back and askfor the check to be cut ASAP. I take theblame. That was a fun 25 minutes!

4:15 Meet with the business office man-ager to go over AR accounts. The number is getting better but still way too many fam-ilies trying to beat the Medicaid system andnot paying the surplus. Not much we can do but keep making the calls and applyingpressure. Review three cases for greater

10:00 a.m. Review RUG levels withIrwin Co, RN, Director of MDS




ance plans and its three-year demonstrationproject in four or five states. Facilities thatachieve either high performance or sub-stantial improvement in quality of care will be awarded incentive payments. The keyquestions for the study are:

■ How should nursing home quality per-formance be measured?

■ How should the payment pool bedetermined?

■ How should performance be linked topayment?

The core domains for the study will bestaffing, appropriate hospitalizations, MDSoutcomes and survey deficiencies.

No-pay billsThe discussion on “no-pay bills” stressed

the October 1st requirement that a SNF willbe required to bill for a “beneficiary that hasstarted a spell of illness under the SNF PartA benefit for every month of the related stayeven though no benefits may be payable.”Also, both a private pay SNF patient not on a skilled stay but in a certified bed and a Medicaid patient in a certified bed, have

to have a “no-pay bill” submitted after dis-charge or monthly while in the certifiedsection of the facility.

RUG refinementsThere is an ongoing analysis of the

SNF PPS Resource Utilization Grouprefinements because the increase from 44 to 53 RUGs has resulted in a 13 percentincrease in payments. The CMS presentercautioned providers that if the ADL score is between four and six, they will not qual-ify for the new nine RUGs, “even if theextensive service and rehab criteria aremet.”

Sex offendersCMS also addressed the problem of

convicted sex offenders residing in nursinghomes with the statement that their rights have to be respected as others and afacility cannot transfer/discharge a personwith a history of sex abuse unless he/shemeets one of the five criteria in CFR483.12. CMS does not have any federalrequirements related to sex offenders innursing homes.

Interpretive Guideline Changes

Completed RevisionsF314 Pressure ulcers (11/04)

F315 Incontinence (6/05)

F501 Medical Director (11/05)

F520 Quality Assurance (6/06)

F521 Psychosocial Severity Guidance (6/06)

Future IssuancesF324/325 Accidents and Supervision

F371/325 Safe Food Handling

F373 Paid Feeding Assistants (new tag)

F334 Influenza and Pneumonia (new tag)

F329/425 Pharmacy Services/Unnecessary Drugs

F309 End of Life/Pain Management

F223-226 Abuse

Advance copies of surveyor guidanceare available at www.cms.hhs.gov/surveycerti-ficationgeninfo/.Click on“Policy and Memosto States and Regions.”

CMS outlines goals during an 8-state regional sit-down CONTINUED FROM PAGE 12

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

The value of PREVACID SoluTab in the Long Term Care setting:

• The only PPI available as an orally disintegrating tablet1-8

• The lowest priced branded prescription PPI9

–Based on WAC (Wholesale Acquisition Cost) pricing per oral tablet/capsule published by First DataBank, Inc., August 2005. WAC is a published price list; actual cost to pharmacy or consumer may differ.

• Cost comparisons do not imply any information regarding efficacy or safety

• Bioequivalent to PREVACID (lansoprazole) capsules

• Versatile administration options

=

To learn about the value PREVACID SoluTab can bring to your Long Term Care organization, contact TAP Pharmaceuticals at 1-800-621-1020.

Safety and Other Information

• Adverse events reported most frequently with PREVACID were diarrhea (3.8%), abdominal pain (2.1%), and nausea (1.3%).

• Symptomatic response to therapy does not preclude the presence of gastric malignancy. PREVACID is contraindicated in patients withknown hypersensitivity to any component of the formulation. Pleasesee the brief summary of the complete prescribing information forPREVACID on the adjacent page.

• PREVACID is indicated for the short-term treatment of GERD (gastroesophageal reflux disease) including erosive esophagitis.

• PREVACID products should not be crushed or chewed.

Phenylketuronics: PREVACID SoluTab contains phenylalanine 2.5 mg per 15 mg tabletand 5.1 mg per 30 mg tablet. REFERENCES: 1. PREVACID Complete Prescribing Information. 2. PRILOSEC® (omeprazole) Complete PrescribingInformation. 3. ACIPHEX® (rabeprazole sodium) Complete Prescribing Information. 4. PROTONIX® (pantoprazole sodium) Complete Prescribing Information. 5. NEXIUM® (esomeprazole magnesium)Complete Prescribing Information. 6. PROTONIX® IV (pantoprazole sodium) Complete Prescribing Information. 7. ZEGERID® (omeprazole) Complete Prescribing Information. 8. NEXIUM® I.V. (esomeprazole sodium) CompletePrescribing Information. 9. Data on file, TAP Pharmaceutical Products Inc.

Prilosec®, Aciphex®, Protonix®, Nexium®, and Zegerid® are not trademarks of TAP Pharmaceutical Products Inc. © 2005 TAP Pharmaceutical Products Inc. 2005-030-06915 11/05 Printed in U.S.A.

PREVACID SoluTab andLong Term Care


Nutrition-relatedcitations declining

Three things to watch forto avoid citations

In general, nutritional issues don’t seem to be cited by AHCA surveyors as much

as they once were — today, they’re not evenin the Top Ten list of most frequently-citedtags. However, there are a few things citedrelated to table heights and not feedingpeople all at the same time, and F371 (safe food handling) is still one of the lead-ing dietary issues, according to AHCA’s St. Petersburg-based Health Services &Facilities Consultant Mary C. Maloney.Here are some others:

HydrationHydration appears to be cited more

often than Nutrition. The most-citedhydration issues have to do with monitor-ing the fluid restrictions for patients withend-stage renal disease. Another issue with ESRD patients, not cited as often,is obtaining appropriate weights. Nursinghomes do not always ensure that they areusing post-dialysis treatment weights forpatients with ESRD on hemodialysis forevaluating nutritional status. This is notalways being care planned. The nursinghome may use the weights from the dialysis center, but often there is a lack ofcommunication between the two facili-ties. Effective communication is neces-sary for the optimal management of theperson with ESRD, particularly for othernursing issues (vascular access, blood pressure, etc.).

Diabetic managementDiabetic management in nursing homes

has improved overall, but sometimes theinterdisciplinary team (including the physician) isn’t aware of the current diabetic management practice guidelines.Practice guidelines for glucose control are not being followed, in terms ofgetting biochemical lab tests done, likeA1C. The IDT doesn’t always look at thefingerstick blood glucose values and slidingscale insulin coverage of diabetic patientsto evaluate their glucose control. Recently,Maloney says she has been noticing somephysicians are paying attention to the



Nutrition-related citations decliningCONTINUED FROM PAGE 16

current guidelines and are lowering thescale for sliding scale insulin coverage from200 mg/dl to 150 mg/dl. The nurses arenot picking up on this and are not givingthe insulin to the patient when the bloodsugar is 175 mg/dl, for example. It mayonly require, say, two units of regularinsulin, but over time, this could affect the patient’s blood glucose control.

Tube feedingsTube feedings are not always being

administered as ordered, so the patientdoes not receive all their nutritionalintake.This is not very common, Maloneysays, but sometimes the patient’s tube feeding is turned off for care, and thensomeone forgets to turn the pump backon.Another issue — equally rare — is chang-ing a tube feeding formula without conferring with the facility dieticianbeforehand. In one case, the changed feeding formula doubled the calories andprotein with the same volume adminis-tered, far exceeding the patient’s require-ments. This case of over-feeding hadpotential poor outcomes, as the patienthad impaired kidney function.

F H C A

Web siteWeb site• NEWS, BULLETINS• MEMBERSHIP• REGULATORY• REIMBURSEMENT

www.fhca.org

Advertise in FHCA

Pulsecontact Ian Cordes at CorecareAssociates, exclusive sales agent

ph: (561) 659-5581fax: (561) 659-1291

e-mail: [email protected]


These are the official online CareerCenters of theFlorida Association Directors of Nursing Administration,

Florida Medical Directors Association, andFlorida Health Care Social Workers Association.

www.fadona.org, www.fmda.org, and www.fhcswa.net

What would you do if youdiscovered the Golden Egg?Visit the CareerCenters at

www.fadona.org, www.fmda.org, and www.fhcswa.net

These are the official online CareerCenters of theFlorida Association Directors of Nursing Administration,

Florida Medical Directors Association, andFlorida Health Care Social Workers Association.

These CareerCenters are a treasured new online resource designed toconnect long-term care industry employers with the largest, most quali-fied audience of nurses, nurse administrators, directors of nursing, nursepractitioners, medical directors, physicians, physician assistants, social work-ers, social service designees, and directors of social services in Florida.

Job Seekers may post their resume (it’s FREE) — confidentially, ifpreferred — so employers can actively search for you.

Let these CareerCenters help you make your next employment connection!

Florida’s First and Foremost Licensure Program*

Online Healthcare Risk Management– Nationally Recognized Faculty Experts –

University of South FloridaOffice of Continuing Professional Educationhttp://www.cme.hsc.usf.edu/hcrm/

Tel: (813) 974-2161Email: [email protected]

*Meets State of Florida Agency for Health Care Administration 120 HourEducational Program Licensure Criteria

A day in the lifeof a nursing homeadministrator

CONTINUED FROM PAGE 13

pressure and make note that at least two ofthem will probably call AHCA as soon asthey get the letter demanding payment.Call DON and let her know to expectAHCA in any day next week.

4:45 Make afternoon rounds with DON.Stop in several rooms to chat with thepatients, several of whom thank us for takinggood care of them. Two even brag about the food.

5:10 Check outside storage area and find it unlocked. Call maintenance man andtell him to come back to the facility andlock it properly. He is not happy.

5:30 Check kitchen for dirty can opener.It is clean.Walk through dinning room andnote that staff is serving properly. The background music is right and the patientsare happy with the food. Head back to the office feeling good.Will check my callsbefore heading home.

6:20 Head for the car, but stop at smok-ing area to chat with a CNA and severalpatients.The aide tells me her vacation daysare not right on her check. Promise to lookinto it. Tomorrow.

4:15 p.m. Go over AR accounts withBusiness Office Manager Pat Fierst

5:40 p.m. Meet with Resident CouncilPresident Peter Meyres


Great ideas for makingmealtime more enjoyable

by Debra Wood, RNDining forum inspires ‘culture change’

Quality Improvement

Eager to improve both the quality of careand the quality of life in their facilities,

more than 150 nursing home staff membersattended a dining forum held at the WinterPark Civic Center to learn more about howto change the traditional dining experienceinto one that’s fun and incorporates choice.

Teresa McCann, RN, Regional Directorof Education and Change Management forthe Institute for Caregiver Education,kickedoff the day-long conference, sponsored by the Teaching Nursing Home, FloridaPioneer Network, Darden Restaurants andthe Winter Park Health Foundation.McCann emphasized the importance ofincorporating the food traditions of thepeople who live in the nursing home andcelebrating their life histories.

Among many good ideas, McCann sug-gested:

■ Offering more food choice in the facility

■ Bringing out food on steam tables so as to enhance the aroma of the food andmake choosing easier

■ Encouraging staff to dine with the people they serve as well as their visitors

■ Liberalizing diets■ Decorating the dining area more like

home (using cloth tablecloths and napkins;bottles instead of paper condiment packets;salt and pepper shakers; glassware rather thanplastic; table centerpieces; napkins ratherthan bibs)

According to McCann, making meals and mealtime more enjoyable will increaseappetites, decrease weight loss, dehydration,medication use and facility-acquired woundsand improve satisfaction.

During breakout sessions, conferenceparticipants learned about best practices indining for people with dementia, how toensure regulatory compliance and the benefit of adding a “wheelchair buffet.”There was also a firsthand success story toldby Lori Jowett, Administrator and MikeMiland, RD, Chief Clinical Dietician, ofFHCA member Health Central Park inWinter Garden.

HCP transformationHealth Central Park began its own

culture change journey slowly in the late1990s. It really took off about two years ago

meals and works with the dietary depart-ment to plan special events, such as ethnicdays or drive-in movie dates, which featureshamburgers or pizza.

“They love it,” Jowett said. “We’ve had no complaints from anybody, including family members, about food. We get highpraise from all corners.”

Eats n’ TreatsSome of the elders at Health Central Park

operate the Eats n’ Treats Country Store,which sells snacks, beverages and easy-to-prepare foods to fellow patients, staff andeven students completing their clinical rotations in the facility. The proceeds aredonated to the HCP Resident Council tofund outings and other amenities. The country store has been so successful thatthose involved with Eats n’ Treats were honored with FHCA’s Group Volunteer of theYear award in 2004.

The dining forum concluded with aninteractive panel of regulatory, qualityimprovement and culture change leadersresponding to questions from participants.At its conclusion, people left the diningforum enlightened about the possibilities ofenhancing quality of life and in how doingso will improve outcomes and overall quality of care.

(Debra Wood is an Orlando-based RegisteredNurse and professional writer. For more informa-tion, contact Cathy Lieblich, coordinator, FloridaPioneer Network at (407) 228-1815, or via e-mail at [email protected].)

after receiving assistance from the FloridaPioneer Network and the Teaching NursingHome. It has converted all its nursing unitsinto “neighborhoods,” each with its ownname. Jowett shared how the neighborhoodsuse “learning circles,” a high involvement,relationship-building technique that ensuresall — including staff — stay involved and participate in the life of the home.

HCP begins the lunchtime meal withservers dishing up hot soup from a specialcart. The soup is served before the entrée,which has enticed people to arrive early andto eat in the dining room instead of theirown rooms. Most dine restaurant-style,selecting from a menu in the main diningroom.

“We’re doing a lot of things to make thedining experience fun,” Jowett said.

The Health Central Park dining programincludes many other restaurant featuresincluding linen tablecloths and napkins,background music, finger towels, a salad bar,a carving station and a dessert cart. The elders in the home are actively involved inall aspects of food planning and preparation— even pie and jam making.

All departments within the nursing homeare involved in the HCP dining program.Office workers wheel people to and fromthe dining room. Human resources staffhelps serve soup. Activities staff serves the

Pitching In: Health Central Park chefWilliam Frazier carves and serves freshroast turkey restaurant-style to “waiter”Sharon Caccia, HCP’s HousekeepingSupervisor. Right, Rubye Waters awaits atureen of delicious hot soup, served up byTerri O’Neal, Human Resources Coordinator.

News from acrossFlorida



Administrator Gary West and two staffmembers of Valencia Hills Health & RehabCenter in Lakeland pose in front of FHCA’sAging in America art exhibit. The exhibitwas featured at the facility’s first QualityFair, in which several local businesses participated.

Miss USA 2005, Chelsea Cooley,meets with staff and patients atThe Haven of Our Lady of Peace in Pensacola; at right, contestantscompete in the sixth annual Ms.Northwest Florida Senior Pageant held in Pensacola. Thirteen repre-sentatives from area nursing homescompeted, emceed by Jeff Nall of theCouncil on Aging. FHCA District XII(Pensacola) raised over $1,500 inprize money for the event, donatedby generous community sponsorsincluding Target Stores, Gulf Power,Covenant Hospice, Baptist HealthCare, PharMerica, Aegis Therapies,Life Care Center of Pensacola andthe Heritage of Santa Rosa. AlmaBell was named this year’s winner.

FHCA Region III Vice President Ben Carotenuto, left, andDistrict IV (Tampa) President Nancy Thurman, lower rowleft, led a delegation of FHCA members who came toTallahassee during the legislative session to advocatefor adequate nursing home funding.

FHCA Pulse welcomes news items,press releases, photos or guest articles of500 words or less. For information, call(850) 224-6242. You may fax items to(850) 224-9823. Information also can be mailed to: Florida Health CareAssociation, P.O. Box 1459, Tallahassee,FL 32302-1459.

Patients and residents of Village on the Isle inVenice donated $32,000, which was dividedinto eight $4,000 scholarships and presentedto nursing staff during a special ceremony.VOTI President/CEO Tom Kelly, at podium,presented the scholarships on behalf of theResident Council.



Spring Hill’s Epley wins CNA essay contest(Editor’s note: Following is the winning entry in FHCA’s annual CNA essay contest, which includes a $500 cash prize.Ms. Epley is a CNA at Spring Hill Health and Rehab Center in Brooksville, where the administrator is Dennis Dijon.)

Often, it’s the little things in life that are the mostmemorable and meaningful to folks.After all, I still

remember the nicest thing my husband ever said to me.The conversation took place 14 years ago. He barelyremembers it, but I will never forget it.Those few kindwords meant the world to me that day. Here is that saga.

I was pregnant with our first child and as big as a barn.I felt just like a big old hippopotamus. I tried on everystitch of clothing in my closet. Naturally, nothing fit me.Feeling sorry for my over-sized self, I sat down on thebed to have a good cry. However, my pity party was cutshort when my husband came into the room and put his arm around me. He said, “Don’t cry.You’re not fat.You’re pregnant, and that’s not ugly, it’s beautiful.” Thenhe kissed me on the cheek and left the room. At thatmoment, the dark storm clouds rolled away and the sunshone brilliantly in my little corner of the world.

Our privilegeAs CNAs, we have the privilege of bringing a little

sunshine into our residents’ lives each time we show upfor work. Sometimes all it takes to brighten someone’sday is a few kind or encouraging words.

When my rehab patients get discouraged, I put myhand on his or her shoulder or take them by the hand. Ilook them in the eye and say,“Don’t give up.You’re goingto make it. Keep trying. Keep doing your therapy.You aregoing to get better but it’s going to take longer than youwant it to. It’s going to be okay.You are going to be okay.”

We caregivers must remember that it is an uphill battle for our residents. Many of them have just beenthrough major surgery, serious injuries, or both. Many are dealing with life threatening illnesses.They have losttheir independence and are no longer in control of their own lives. They are frightened, in pain and at themercy of the medical professionals.They are facing somemonstrously big problems. They need all the TLC,encouragement and kindness that we can dish out tothem.We must remember to treat them as we, ourselves,would like to be treated if we were standing in theirshoes. Who knows, maybe someday we will be.

Honoring requestsA tried and true way to brighten a residents’ day is by

honoring their requests whenever possible, no matterhow odd or quirky their request may sound. For

example, I once took care of a man who wanted to sleepcompletely nude with the air conditioner cranked wayup high.This seemed very strange to me, but it made himfeel comfortable and content. His request was grantable as long as the staff took extra care to make sure all thecurtains were pulled completely around his bed in orderto respect his privacy.

Another offbeat request came from a little old ladywho was deathly afraid of germs. She was thoroughlyconvinced that she would become infected by some hor-rible disease just from sitting on the toilet. Her fears wereeasily quelled. Her family gave her a can of disinfectantspray. She carted it around with her in her wheelchairwherever she went. Before allowing the staff to help heronto the toilet, she would hand them the spray can.She wanted the toilet seat to be quickly sprayed andwiped. If this was done for her, she was happy and smileyall shift long. If her request was denied, she would fretmiserably and complain about all those nasty germscrawling around on her tail end from the dirty old toiletseat. Her sunshine for the day came out of a spray can.If you used the spray, you brightened her day.

Spreading sunshineAs CNAs, we can’t do a whole lot about the big prob-

lems that our residents must face. However, there are hun-dreds of little ways to brighten a resident’s day and spreadsunshine. So, if he wants a scoop of strawberry ice creaminstead of vanilla for a bedtime snack, well, sure, why not?If she needs a hug or a pat on the back to help her makeif through the day, by all means, give her one. If he feelsrestless and can’t fall asleep, try giving him a back rub tohelp him relax. If she feels sad and droopy and a flowerwould cheer her up, just slip outside and pick her one.

These are all just little things but, after all, it’s the littlethings that make up life. Quite often it’s the little thingsthat matter most to folks. It’s the thoughtful and com-forting little things that our residents remember the most.

“Caring is our business”by Cheryl Epley

Congratulations to runners-up2nd placeSonya PowellRidgecrest Nursing & RehabDeLandAdministrator: Greg KnowlesMs. Powell wins $300

3rd placeLisa AndrewsBayview CenterEustisAdministrator: Linda GraverMs. Andrews wins $200


As we write this, the great relief we felt afterthe 2006 legislative session just vanished

with Gov. Jeb Bush’s veto of the $25.6 millionfunding restoration and the $65.5 million thatwas going to provide long-overdue relief fromprovider targets.

Even though his budget as originally proposedcontained a repeal of the 2.9 minimum mandato-ry CNA staffing increase,Bush could not veto thestaffing increase because doing so would havecaused a reversion to the prior statute, whichrequired the increase to take effect July 1st of thisyear, and would have eliminated some other relief(see below). Funding of the Medicaid portion ofthe cost associated with the increased staffingstandard is still in the budget,which we estimate tobe somewhere between $3.50 and $4.50 per patientday.Many details remain to be worked out, but wehope those facilities that will have to hire and trainthe additional CNA staff to meet the new standardwill be able to receive automatic rate increases to par-tially fund their “staffing up” costs in Novemberand December. Of course, your facility will likelyhave to try and increase private-pay rates to payfor the non-Medicaid share of the cost becauseMedicare payment rates won’t change.

On a more positive note, restoration of fund-ing for the Medicaid Adult Dental, Hearing andVision program — including funding for partialdentures — survived and legislators also rebuffeda proposal to give the Agency for Health CareAdministration a “free pass” on Florida SeniorCare, so the legislature must still approve the planif CMS approves it.We understand CMS recentlyreturned the proposal with questions that indicateserious concerns with the waiver. If true, thatmeans the FSC pilot programs will in all likeli-hood have to wait until at least July 2007 tobegin, because it is extremely unlikely that a special session of the legislature will be called anytime before mid-November, and that’s assum-ing federal waiver permission is obtained.

Leased facilitiesLeased facilities will get a break when the new

provisions of Chapter 400.179, Florida Statutes,related to bond requirements for leased facilitiesare implemented. Specifically, the alternative feethat a leased nursing facility must pay to AHCAin lieu of obtaining a lease bond was reducedfrom two percent to one percent of threemonths-worth of Medicaid payments.

Certificate of NeedSome facilities are having difficulty complying

with conditions placed on their certificates whenthey were issued, especially those CONs requir-ing certain levels of Medicaid occupancy. There is a proposed rule which acknowledges and listssome mitigating factors that AHCA may use inreducing or eliminating fines for non-compliancewith these conditions, which should give AHCA

more leeway in waiving fines.Any mitigating fac-tors that AHCA currently accepts would still beavailable under the new rule.This is a good thingbecause the original proposed rule mandated thefine but did not have any reference to mitigatingfactors. We hope AHCA will not need to revisethe rule if and when Florida Senior Care isimplemented, since this would be an obvious mitigating factor. Also, language was added to this session’s CON moratorium bill which willprovide for automatic reductions in CON condi-tions for Medicaid occupancy in any area wherea nursing home diversion program exists.

Legislation also passed this session allowinghigh-occupancy (96% or more) buildings withexcellent survey history, in subdistricts with over94 percent average occupancy, to add a limitednumber of community beds.The four areas men-tioned in last fall’s Senate report with occupancyabove that threshold were: Leon County,Columbia/Hamilton/Suwannee counties, Nassau/north Duval counties and Seminole County.

Medicaid Low-occupancyThe recent change removes the adjustment

from the patient care component and will limitthe adjustment to no more than 20 percent of theapplicable component’s ceiling. These changesshould become effective July 1st of this year and willbe of significant benefit for those facilities affected.

Medicare cost reportingAt a recent meeting in Baltimore, CMS ad-

vised it has changed the effective date for the newTransmittal 6 version of the form 339 (ProviderCost Report Reimbursement Questionnaire),which is essentially a cleaned-up version of theold form. The effective date has been changedfrom reports filed on or after May 1, 2006, to costreporting periods ending on or after March 31,2006. Also effective with reports ending on orafter March 31, 2006, home offices will no longerneed to submit a form 339. CMS also indicatedthat if a report has already been filed (for exam-ple, a December 31, 2005 YE) with either thenew or old form 339, the Fiscal Intermediary isto accept it. No reports already filed are to berejected because of the new 339 being submitted.

Open Door ForumCMS advised listeners on the recent Open

Door Forum call of postings to CMS’s SNF BestPractices Web site, including sample agreementsfor arrangements between an SNF and its suppli-ers, SNF Request for Ambulance Transportationfor a Beneficiary in a Medicare Part A Stay, sev-eral Notices to a Physician Treating a Beneficiaryin a Medicare Part A Stay, and a Notice to aHospital Treating a Beneficiary in a Medicare PartA Stay on an Outpatient Basis.To read them, goto www.cms.hhs.gov/snfpps/08_bestpractices.asp.

A very rude awakening indeed!LTCBUSINESS

NEWS

by Steven R. Jones, CPAand Lorne Simmons

Moore Stephens Lovelace

More funding high-lights (and lowlights)of the 2006 legislative session


Unsprinklered facilities on theState Fire Marshal’s to-visit list

by Max Hauth

Deadlines approach for full facility sprinkleringIn order to comply with Chapter 633.022,

Florida Statutes, and Rule 69A-3, FloridaAdministrative Code, the State Fire Marshalannounced that officials from his office,representatives from the local fire authority’soffice and a fire safety surveyor from theAgency for Health Care Administration willsoon be visiting every one of the 30-35non-sprinklered nursing homes in Florida.

The nursing home and its owner(s) willbe made aware of the state requirements ofhaving hazardous areas fire sprinklered byDecember 31, 2008, and being fully sprin-klered no later than December 31, 2010.

The representative from the State FireMarshal’s office will also have availableinformation and applications to participatein the State Fire Marshal Nursing HomeLoan Guarantee Program, which is intendedto mobilize private funding for the instal-lation of required fire sprinkler systems inunprotected, eligible nursing homes withinFlorida.

AHCA prior approvalIn addition to all local permitting and

before the installation of the fire sprinkleredsystem is undertaken by the nursing home, aplan review of the sprinkler system will berequired by the Office of Plans andConstruction, Agency for Health CareAdministration. If you have any questionsconcerning the submission of plans, pleasecontact Skip Gregory, Bureau Chief, Officeof Plans and Construction at (850) 922-6469.

The sprinkler plans and installation of thesystem will also be required to be reviewedthrough the State Fire Marshal’s office as apart of the loan requirements.

Facilities found to not be fully sprinkleredafter the dates listed in this notice may besubject to administrative sanctions by theDivision of State Fire Marshal, per Chapter633.022(4)c), F.S.

Items to considerItems to be considered if the facility is not

sprinklered or not fully sprinklered:■ Does the engineer or sprinkler compa-

ny have the engineering capability, profes-sional licenses and experience required forcompleting the necessary design work?

■ Is there an adequate supply of water tothe facility to be sprinklered?

Unsprinklered or Partially-Sprinklered Nursing Homes*

■ Will the existing fire alarm panel handlethe additional sprinkler zones?

■ Are all the areas including patient roomclosets currently sprinklered?

■ Are the hazardous areas in the non-sprinklered building sprinklered by thedomestic water system, and if so will theyinitiate the fire alarm if activated?

■ What is the building type and does itcontain asbestos?

■ What is the cost of the project?

■ How will this affect the patients andstaff during the completion of the project?

■ What is the possibility of getting theproject completed within a reasonable timeframe?

Steam tables warningSeveral Florida facilities have received

Immediate Jeopardy citations for servingfood off their steam tables in the diningroom. Surveyors reason that patients are at risk when the steam tables are left unat-tended and the patient reaches into thetable. Citations were also given because thetables were not equipped with proper sneezeguard protection and food serving temper-atures were less than what is required.

(Max Hauth is President,Hauth Health CareConsultants, Lakeland, and a frequent contributorto FHCA Pulse on life safety issues. Contacthim at (863) 688-0863.)

Avante at Mount DoraCrestwood Nursing Center, PalatkaIHS at GainesvilleLakewood Nursing Center, BradentonLakeview Terrace Nursing Center, AltoonaWestminster Care of Delaney, OrlandoCarnegie Gardens Nursing Center, MelbourneEdward J. Healey Rehabilitation and NursingCenter, West Palm BeachWhitehall at Boca RatonAbbiejean Russell Care Center, Fort PierceFort Pierce Health Care CenterTerraces of Lake Worth RehabilitationCathedral Gerontology Center, JacksonvilleDaytona Beach Health & Rehab CenterEartha M.M. White Nursing Home, JacksonvilleGovernor’s Creek Health & Rehab, Green Cove SpringsSandal Wood Nursing Center, Daytona BeachSouthwood Nursing Center, JacksonvilleSt. Augustine Health & Rehab CenterPalm Terrace of St. PetersburgHeritage Park, Dade CityLaurell Wood Nursing Center, St. PetersburgPasadena Manor, South PasadenaSprings at Boca Ciega Bay, St. PetersburgManor Pines Convalescent Center, Fort LauderdaleMedicana Nursing and Rehabilitative, Lake WorthOcala Health & Rehab CenterCrystal River Health & Rehab CenterWest Melbourne Care CenterRoyal Care of Avon ParkFort Lauderdale Health & Rehab Center

ered facilities.

Avante at Mount DoraCrestwood Nursing Center, PalatkaIHS at GainesvilleLakewood Nursing Center, BradentonLakeview Terrace Nursing Center, AltoonaWestminster Care of Delaney, OrlandoCarnegie Gardens Nursing Center, MelbourneEdward J. Healey Rehabilitation and Nursing

Center, West Palm BeachWhitehall at Boca RatonAbbiejean Russell Care Center, Fort PierceFort Pierce Health Care CenterTerraces of Lake Worth RehabilitationCathedral Gerontology Center, JacksonvilleDaytona Beach Health & Rehab CenterEartha M.M. White Nursing Home, JacksonvilleGovernor’s Creek Health & Rehab,

Green Cove SpringsSandal Wood Nursing Center, Daytona BeachSouthwood Nursing Center, JacksonvilleSt. Augustine Health & Rehab CenterPalm Terrace of St. PetersburgHeritage Park, Dade CityLaurell Wood Nursing Center, St. PetersburgPasadena Manor, South PasadenaSprings at Boca Ciega Bay, St. PetersburgManor Pines Convalescent Center,

Fort LauderdaleMedicana Nursing and Rehabilitative,

Lake WorthOcala Health & Rehab CenterCrystal River Health & Rehab CenterWest Melbourne Care CenterRoyal Care of Avon ParkFort Lauderdale Health & Rehab Center

*Facilities on this list are those identified byAHCA and FHCA.This listing may not beinclusive of all unsprinklered facilities.

LABORRELATIONS

COUNSEL

by Mike MillerKunkel, Miller & Hament

FHCA Labor RelationsConsultant

Celebratory conduct aftersupervisor’s sudden deathjustified discharge, holdsfederal court

In a case involving a Florida health care insti-tution, a federal trial court recently granted sum-mary judgment to the employer in a case involv-ing race and religious discrimination claims afteran employee was fired for celebrating the suddendeath of her supervisor.The black plaintiff in thiscase had a “rocky” relationship with her whitesupervisor, who had written up the plaintiff andgiven her below-average evaluations.The plaintiffalso had accused her supervisor of making a racialcomment. The supervisor had a sudden illnessthat resulted in her death and the plaintiff told co-workers that it was “God’s wrath,” that the super-visor had “reaped what she sowed,” and that “the Lord’s will has been done.” She also made thestatement, “Praise the Lord…God is good…Sheconstantly mistreated and today she’s in the

judgment.” Some of the plaintiff ’s co-workerswere so troubled by her celebratory conduct thatthey could not go back to work. Her remarksbecame the “talk of the department” and disrupt-ed productivity. Management fired the plaintiffafter her conduct was reported, and she sued.On the religious discrimination claim, the courtreasoned that it was not the religious nature of the plaintiff ’s comments that led to her discharge,but rather her inappropriate conduct in openlycelebrating the death of a supervisor and the disruption it led to in the workplace.The lessonof this case is that employees do not have an openlicense to say whatever they want in the privateworkplace.

Employer’s failure to hireevangelical Christian mightconstitute religiousdiscrimination

While an employer ordinarily has substantialleeway in considering the qualifications of aprospective employee, another recent federal casedemonstrates the importance of avoiding a deci-sion based on perceptions or stereotypes. This case involved a religious discrimination claimbrought by an evangelical Christian plaintiff whowas turned down by the employer because it fearedshe might try to “speak God” to its clientele.Theplaintiff was qualified for the job (in fact, over-qualified according to the employer) and also list-ed on her résumé that she had spread “the wordof God” to prison inmates and troubled teenagegirls.The employer was a nonprofit organizationwhose clientele largely consisted of homeless per-sons with psychiatric and substance abuse issues.It had a policy of “consumer choice,” meaningthat clients were free to accept or reject servicesthat were offered. The employer apparently haddoubts as to whether the plaintiff would prosely-tize if hired (the plaintiff alleged that she told herinterviewer her religious views would not inter-fere with work) and decided not to offer her theposition.The EEOC sued on the plaintiff ’s behalfand the court denied summary judgment to theemployer, finding the facts were disputed as towhether the employer’s decision was based on astereotype that evangelical Christians are com-pelled to spread the word of God or on legitimateconcerns that the plaintiff ’s hiring necessarilywould conflict with the employer’s “consumerchoice” philosophy. Due to the two different ver-sions of what was discussed during the plaintiff ’sinterview and the implications that might arisefrom a review of her résumé, the court ruled thata jury trial would be needed to determine thesedisputed facts.


Letters from across FloridaTimely attention

“I was talking on the telephone to my daughter in Okeechobee, Florida.When I reached for my phone I slipped off the bed and couldn’t get back on. I tried all the ways of return-ing to the bed to finish my call, only I could not get up.Well, I yelled to my daughter thatI could not get up to talk. She called this establishment and in came enough staff to set meon the moon. It is the only time I have really needed help…Thanks for the good service Ineeded.”

— 94-year-old patient Beatrice Abbot, to the staff at Marianna Health & Rehabilitation Center.

Open arms“I cannot find the words to express my gratitude to all of you.We were welcomed with

open arms and everyone was so kind to us… If some day, I need to be admitted to a facili-ty such as yours, I would hope that there would be room with you for myself because of the care I saw that you give to those that are in need. May God bless each and every oneof you is my prayer.”

— Lois S.Tyre, the spouse of a former patient, to the staff at Bay Pointe Nursing & Rehabilitation Center in Lake City

Kind acts“We would also like to express our sincere thanks to all of you for the hard work, care,

and attention given to my mother, Marie Williams, during her two years with you.Yourmany kind acts and your friendliness are so appreciated.Thanks also, Scott, for coming to thefuneral home. I really appreciate it.”

— Sharon and Steve Miller & all the family of Marie Williams to administrator Scott Allen and the Palm Garden of Tampa staff

* * *Send FHCA Pulse a photocopy of your favorite card or letter from a satisfied

patient or patient’s family member. Send to FHCA, P.O. Box 1459,Tallahassee, FL32302-1459, or fax to (850) 224-9823.The best will be posted on the FHCA Website and excerpted in FHCA Pulse.

Employees’ rights to speak freely arenot absolute


FHCA congratulatesnurse leaders

Irena BlackburnTandem Health Care

of Winter Haven

Tina ShookSandy Ridge Care Center,

Milton

Ron LeitterMiami Jewish Home &Hospital for the Aged

Joy SacayananSt. Catherine Labouré Manor,

Jacksonville with FHCA President Dion Sena

FHCA presented its Outstanding Nurse Leadersawards during a luncheon at this year’s Nurse

Leadership Training Program at the Don CeSarResort & Spa in St. Pete Beach. The first Treasure Our Elders award was presented to Carolyn Crisp ofThe Heritage of Santa Rosa in Milton. The award is presented for outstanding service to the elderly.

Nurse Administrators of the Year

Registered Nurseof the Year

Licensed PracticalNurse of the Year

2006 FHCA Nurse LeadershipTraining Program

An impromptu conga line was part of thefun at this year’s FHCA Nurse LeadershipTraining Program held at the Don CeSarResort & Spa in St. Pete Beach. Below,FHCA Treasurer Nina Willingham sang atribute to the 200+ nurses gathered at theawards luncheon. The popular three-daytraining helps nurses from FHCA memberfacilities develop their professional abilitiesand leadership skills.


American Health Care Association and National Center for Assisted LivingAHCA/NCAL offer hundreds of long term care professional development resources. Categories include Care Practice,Compliance & Regulation, Staffing & Retention, Consumer Resources, Nurse Aid Training, Assisted Living and manymore. Go to www.ahcapublications.org or call (800) 321-0343 Monday - Friday, 9 am - 6 pm to place an order.

Edge Information Management Inc.Since becoming an approved service corporation company for FHCA in 1993, Edge has helped over 250 FHCAmembers meet their background screening requirements and kept them informed of pertinent legislative issues.Edge offers a variety of background checks including: drug screening, fingerprints, criminal, sexual offender,license verifications and references. Call (800) 725-3343.

Entrees to HealthEntrées to Health is Florida’s premiere USDA-approved manufacturer of enhanced protein-based products, gourmetentrées and complete meals. Our delicious product offerings are uniquely formulated to provide maximum nutritionalbenefits for patients suffering from diabetes, renal failure, obesity, heart disease and more. A sister company toFood With CareTM Inc., Entrées to Health is dedicated to providing the highest quality products with compassionand integrity. For additional product information please visit us at www.entreestohealth.com, or call us at (407)936-0340 ext.12.

FMS Purchasing & ServicesFMS has a full line of products and services in its Group Purchasing Program. FMS services member needs by ensuringmaximum savings and service. Five area managers throughout the state assure members an immediate response. Our services include: audits, a toll-free number, cost analysis, service reports and the Manufacturers Value IncentiveProgram. Call (800) 456-2025.

Hamilton Insurance AgencyHamilton Insurance Agency has 25 years experience, with an emphasis on the healthcare industry, and is proud toprovide the best and most economical services available in the industry to its customers. Offering commercial,health, personal and a variety of specialty services like Risk Management consulting, COBRA and Workers’Compensation. Contact Geoffrey Shisler at (877) 260-9468 or via e-mail, [email protected].

MED-PASS, Inc. (Heaton Resources)MED-PASS is a nationally known company specializing in the research and development of documentationsolutions, policy and procedure manuals, regulatory guides and in-service training programs for the long-termcare professional. Our manuals and guides are comprehensive, easy-to-use and continuously updated. Our formsand resources offer peace of mind and quality and better than competitive prices. Call (800) 438-8884.

Office DepotOffice Depot offers Florida Health Care Association members extra discounts and services due to the cooperativepurchasing power of FHCA. We offer a wide variety of benefits, including 50 items which have been reduced basedon volume ordering up to 80 percent off the list prices (the “High Use Item List”); next-day delivery on any amountof products (no minimum order); an award-winning Web site which links you to your pricing and into the ware-house and keeps 18 months of tracking information at your fingertips. Call (800) 422-2654 for information or toset up an account; call (800) 386-0226 to place an order.

SCI CompaniesStaffing Concepts of Florida, Inc. is a professional employer organization which provides a comprehensive solution toyour personnel needs, including: employee benefits; workers compensation and safety programs; human resourcessupport; and payroll. SCI specializes in helping health care facilities better manage their single largest cost— labor.Call (800) 932-4610.

Senior CrimestoppersThe Senior Crimestoppers program is a proven, effective, proactive crime prevention system that combinesproven components to help provide safe, crime-free facilities for patients, staff, visitors and vendors. Personallock boxes for use by residents and/or family members, an around-the-clock, completely anonymous “tip line”call center, cash rewards of up to $1,000 posted on any and all incidents that occur and educational materialsfor residents, families, management and staff members are a few of the components that make up the program.More details can be found at www.seniorcrimestoppers.org or contact Donna Derryberry at (800) 529-9096.

FHCA SERVICE CORPORATION SAVES YOU MONEYWe are proud to recommend these fine vendors who provide

quality goods and services. They help keep you and FHCA on top!

FHCA Bulletin Board(Note all programs preceded by an asterisk (*) have registration brochures available via FHCA Fax-on-Demand at(850) 894-6299. Some meetings noted herein may also carry CE credits. Additional information can be found at www.fhca.org. Click on “Seminars/Events.”)

Continuing Education/Training

Dementia-Specific Training forPT, OT, ST and theInterdisciplinary Team Friday, July 28Hillcrest Nursing & Rehabilitation Center4200 Washington Street Hollywood

Program runs 8:30 a.m. to 5:00 p.m. Approved for seven contact hours of continuing education credit for NHAs, nurses, social workers and physical, occupational and speech therapists

Meetings/Events

FHCA–FCAL 2006 AnnualConference & Trade ShowWednesday, July 5 through Saturday, July 8Gaylord Palms Resort & Convention Center6000 West Osceola ParkwayKissimmee

Call (407) 586-0000 for directions or general resortinformation. The Gaylord Palms is currently atcapacity in our room block, but you can makereservations at the Orlando World Marriott at (800)621-0638; the room rate is $149. The Marriott islocated less than a mile from the Gaylord Palms.


PulseIn addition to all FHCA members and associate members, FHCA Pulseis also mailed to legislators, opinion leaders, reporters and state/federal regulators in Florida. The wider distribution allows others to better understand long term care and the daily challenges facedby the long term care providers we represent.

Note to FHCA Pulse readers

by Peggy RigsbyFHCA Government Services Director

For FHCA members only, Ms.Rigsby has inserted in this com-bined June-July issue of FHCAPulse a 20-page comprehensivesummary of all long term care-related legislation that was con-sidered during the 2006 Floridalegislative session. The documentis also available at www.fhca.orgunder “Members Only.”

Her regular monthly columnwill resume in August.

Look forLegislative insert

Documents

Pulse June/July 2006 - FHCA