Fall 2015

A publication for Wisconsins Long-Term Care Profession by

Building for the Long Term

Wisconsins LTC Facilities Invest $1 Billion in Their
Buildings to Provide Modern, Effective Therapy

Including:
Budget Review, Fall Session Preview
Staffing AgencyWorkers:
Dont Assume YouareAvoiding Employment Law Requirementsand Risks
How Data Influences Policy: The Role of Analytics and Statistics

ANALYZE

Welcome
Milestones

WHCA/WiCALs

The Fall 2015 issue of Continuum is being released as

a part of the 2015 WHCA/WiCAL Fall Convention,
and comes at the same time that our community of
providers offers its best wishes in retirement to one of
our Associations long-standing champions.

OVER 25 YEARS SERVING SENIOR CARE FACILITIES

In his 32 years of service as Executive Director, Tom has

advanced and represented the interests of the Association
and its membership before the respective administrations
of 5 U.S. Presidents and 5 state Governors.

Website planning and strategy

Budget-friendly design options

Given the scope, intensity of the unceasing change

the profession and membership have experienced over
the past thirty years, my tenure as Executive Director
seems to have passed in the blink of any eye, he said
in the announcement of his retirement. However, I
realize that successfully addressing the new and complex
challenges that loom on the horizon will require an
enormous commitment of additional time and energy
that is difficult to reconcile with the DOB that appears
on my drivers license Its a perfect and exciting time
for me personally and WHCA/WiCAL professionally
to move on.

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Copywriting and photo support
Social media and email marketing support

DESIGN

DEVELOP

ENHANCE

This summer, WHCA Executive Director, Thomas P.

Moore informed the WHCA Board of Directors of his
intention to retire in early 2016. Tom first aligned with
WHCA (then known as the Wisconsin Nursing Home
Association) in 1984 serving as its first in-house Legal
Counsel. He was appointed by the Board of Directors
to the Executive Director position in January 1986
when the Associations first Executive Director, George
F. MacKenzie stepped down after 30 years

of service.

WHCA Board President Mike Schanke offered the

following in the announcement of Toms retirement.
Throughout his tenure as Executive Director, Tom
has steered WHCA through many complicated

DEPLOY

Call 800-448-5213 or visit www.illuminage.com for more information and to discuss your needs.

problems in the areas of reimbursement, regulatory and

legislative affairs, Schanke said. Tom has faithfully
and impartially represented the varied interests of our
profession these many years and I know I speak for the
entire membership in offering Tom our best wishes in
his retirement.
v

In this issue of Continuum, WHCA/WiCAL offers readers

articles on several topics of concern to our states long-term
care providers. The Cover Story in this issue highlights
the significant investment that providers are making to
ensure that our residents receive the best care possible.
In Stakeholder Spotlight, HealthCare Interactive CEO
John Hobday offers insights into the origins of WHCA/
WiCALs new on-line dementia education partner. In
Capitol Connection, we breakdown the 2015-17 State
Budget signed into law over the summer and previews
the upcoming fall floor period.
In the other sections of the magazine: the LTC Legal
Letter explains some of the potential legal implications
of using a staffing agency; a new column, Data
Digest offers background on the use of data in the
public policymaking process; and finally in Clinical
Corner, WHCA/WiCALs on-line education partner,
CE Solutions offers insight on the issue of influenza
immunizations.
As always, thank you for taking the time to read Continuum!
Sincerely,

John J. Vander Meer

Managing Editor
Continuum

Fall 2015 | CONTINUUM 3

Advertiser Index
2

IlluminAge

Specialized Medical Services, Inc.

Health Direct Pharmacy Services

McKesson Medical

JT and Associates, LLC

17

HME Home Medical

17

WHCA/WiCAL SC

17

Marsh & McLennan Agency

18

Navigator Group Purchasing Inc.

20

Wipfli

20

Martin Bros. Distributing Co. Inc.

20

Badger Graphic Systems

21

MJ Care

21

OConnell Pharmacy

27

CE Solutions

28

M3 Insurance Solutions

Fall 2015

Contents
6
Continuum is published for the
Wisconsin Health Care Association
and the Wisconsin Center for
Assisted Living
131 W. Wilson Street, Suite #1001
Madison, WI 53703
Phone: 608.257.0125
Fax: 608.257.0025
www.whcawical.org

10

12

14

We take a team approach at HealthDirect, including having

a designated customer service and pharmacy technician
for your facility, a personal billing representative to answer
your staff and family member questions, and much more.

For more information, contact:

Steve Jansen
Phone: 608-784-6500 ext 301
Cell: 608-738-1141
[email protected]

4 CONTINUUM | www.whcawical.org

1155 Wilburn Road

Sun Prairie, WI 53590
608.834.3400
www.bgsinc.com

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For more information in advertising in

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.
2015 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 OCTOBER 2015

CLINICAL CORNER
2015-16 Influenza Immunization Update
Pending Legislation, Risks and Resources

COVER STORY
Building for the Long Term
Wisconsins LTC Facilities Invest Hundreds of Millions in Infrastructure
Over the last five years, Wisconsins skilled nursing and assisted living facilities have invested
nearly $1 billion in their buildings and campuses to provide residents with the best modern
and effective long-term care and rehab therapy services. Todays LTC facilities provide all of
the amenities and cutting-edge therapy options that residents and their families have come
to expect. In Wisconsin, a DHS study found that the over-85 population will increase 140
percent between 2010 and 2040. As a result of this increasing need, providers have still
found ways to invest in their buildings despite the states limited reimbursement.

Published by

HealthDirect, Institutional Pharmacy Services has many

years of experience in serving the unique needs of Assisted
Living and long term care facilities. We are committed to
providing our customer with the most comprehensive and
progressive pharmacy services available, at HealthDirect
we can tailor a program to meet your individual facilitys
needs, whatever they may be.

The Role of Analytics and Statistics

The flu season has arrived have you gotten your flu shot yet? In long-term care organizations,
as well as acute care settings, it is beneficial to increase vaccination efforts for your staff and
residents to assist in creating a herd immunity against the flu. Flu isnt just an inconvenience;
its a killer: its estimated each year between 3,000 up to 49,000 people died due to fluassociated deaths in the United States.

Account Manager
Abbie McDowell

Layout & Design

David Cox

DATA DIGEST
How Data Influences Policy
Data use in policy decision making has been growing with the advent of more sophisticated data
systems and programs. However, as data has proliferated, it has also been important to understand
appropriate means to gather data, accurately operationalize performance, and understand the
problems facing the people who report data. In order to improve care and optimize performance,
skilled nursing and assisted living facilities need to become more data-driven.

Editor
Melissa Keller

Creative Director
Sara Rice

State Budget, Legislative Background for Providers

Following weeks of state agency briefings and public hearings, in mid-April the Joint
Finance Committee began its actions on the many fiscal and policy issues contained in the
budget bill. Capitol Connection provides detailed background on provisions passed into
law as a result of the budget, and offers a preview of forthcoming issues in the 2015 Fall
floor period.

Managing Editor
John J. Vander Meer
Publisher
Dean Gille

CAPITOL CONNECTION
Budget Review, Fall Session Preview

STAKEHOLDER SPOTLIGHT
CARES Online Training and Alzheimers Association essentiALZ Certification
Personal Connection to Alzheimers Leads to Development of Online Dementia
Care Training and Certification Program
The story is hardly unique. A woman in her late-80s begins to decline with memory issues,
stops some of her favorite activities like cooking, sewing, and gardening, and eventually forgets
to eat or drink for days. Her hygiene suffers, she seems confused and uneasy at family events,
no longer recognizes some family members or neighbors, and even becomes incontinent. This
personal experience leads to creation of a celebrated online dementia care training programs.

22

LTC LEGAL LETTER

Staffing AgencyWorkers:Dont Assume YouareAvoiding Employment
Law Requirementsand Risks

Many providers erroneously think that since temporary staffing workers are not their direct
employees they do not assume any employment or labor law responsibilities as to these
individuals. Unfortunately, this is not true, as in some circumstances providers can be considered
joint employers of temporary workers which may expose the provider to responsibilities
towards the contracted personnel.What terms should you pay particular attention to?

Fall 2015 | CONTINUUM 5

Capitol Connection

Budget Review,
Fall Session Preview

State Budget, Legislative Background

for Providers
By Jim McGinn

n the Spring Issue of Continuum, an

overview of Governor Scott Walkers
proposed 2015-17 biennial budget
bill, Senate Bill 21, was provided in
the Capital Connection report.

It may be helpful to review some

of the issues and positions WHCA/
WiCAL advanced to the Joint
Finance Committee and the
Legislature during its consideration
of the biennial budget bill.
In late March, members of WHCA/
WiCAL met in Madison at our
Legislative Day program and were
briefed on the budget by Wisconsin
Department of Health Services
Secretary Kitty Rhoades and Assembly
Speaker Robin Vos (R-Rochester).
Following their presentations, our
members met with their Legislators
and expressed support for and concerns
with the following issues:
Although the Governors
budget included a significant
cost-to-continue
increase
in
Medicaid
funding
($657 million), it offered
no additional funding to
support
reimbursement
increases for nursing homes
or other Medicaid/Family Care
providers.
With respect to skilled
nursing facilities, WHCA/
WiCAL requested support
for restoration of the nursing
home bed tax skim ($15
million all funds) and
6 CONTINUUM | www.whcawical.org

support for $18.7 million

(all funds) to address nursing
home resident acuity care
needs as identified by DHS.
WHCA/WiCAL
requested
support for requiring MCOs
to pass-thru some of the
increase in capitation rates to
providers who actually deliver
the needed care and services
to enrollees, and support
for maintaining current law
permitting consumers to select
any willing provider for their
long-term care services.
Finally,
WHCA/WiCAL
recognized and supported the
need for extensive changes in
the states current Family Care
model, but could not support
the Governors dramatic
change without additional
information regarding the
change, including how, when
and by who those changes
would be structured and
implemented.
Following weeks of state agency
briefings and public hearings, in midApril the Joint Finance Committee
began its actions on the many fiscal
and policy issues contained in the
budget bill. Identified as executive
sessions,
committee
members
reviewed Legislative Fiscal Bureau
papers prepared on specific subjects,
discussed the papers, asked questions
of staff, and then voted to recommend
passage of the subject discussed.

For example, on May 27, the Fiscal

Bureau prepared Paper #362, an
11-page memo that reviewed MA
Reimbursement for Nursing Homes.
The paper briefly identified the
current reimbursement payment
system and noted the Governors
budget provided no increase in
funding for MA reimbursement for
skilled nursing facilities. Fiscal Bureau
staff noted the continuing increase in
the acuity of nursing home residents
has played a significant role in the
growth in nursing homes costs.
Accordingly, the Committee voted to
appropriate $7.6 million (all funds)
to provide a 1% acuity increase to
skilled nursing facilities in 2016-17,
the second year of the biennium.
The Finance Committee continued
voting on various provisions in the
budget bill through Memorial Day,
but a month-long stalemate developed
between the two Houses. For several
weeks, the focus of concerns and
debate on the budget centered
on funding for the transportation
budget and possible delays in major
state highway projects; the states
prevailing wage law; a new arena
for the Milwaukee Bucks, and for
several days on possible changes to
Wisconsins open records laws. While
the Milwaukee Bucks arena was not
included in the final budget bill, the
remaining issues were resolved.

signed the budget on Sunday, July

12, and on Monday announced that
he was running for President of the
United States in the Republican
Presidential Primary.
The Governors 48-page veto
message provided a summary of the
issues and vetoes he believed will
continue to make Wisconsin more
prosperous, more independent and
more efficient. With respect to the
104 vetoes, the Governor noted
these vetoes will reduce overall
spending, constrain earmarks, allow
the executive branch to efficiently
perform its statutory duties and
correct legislative errata. These vetoes
increase the general fund balance by
$44.5 million (GPR-state dollars)
over the biennium.
Governor Walker stated the budget bill
he signed preserves essential safety net
programs, including Senior Care and
Medicaid, while implementing reforms
to slow expenditure growth and
maintain essential health care services;
increases Medicaid reimbursement
for nursing homes through an acuity

adjustment; expands Family Care

statewide and improves the integration
of long-term care and acute and
primary care services.
Specific vetoes included:
Family Care: the Governor
vetoed the requirement that
there be no less than 5 long-term
care regions because I object
to creating a fixed number
of regionsthe requirement
for a separate actuarial study
for integrated health agencies
since state and federal law
require rates be actuarially
soundand the requirement
the open enrollment period
coincide with Medicare
the department will set an
open enrollment period that
makes sense for Wisconsin
consumers.
Labor Region Methodology
Study:
the
Governor
vetoed this provision to
eliminate the labor region
methodology requirements,
as these requirements are
administratively burdensome

and
duplicative.
The
department already regularly
evaluates the labor region
methodology
and
may
recommend changes if needed.
County-to-County Nursing
Facility Bed Transfers: the
Governor vetoed this section
because it is unnecessary.
Current law already specifies
the requirements that must be
met for a transfer of licensed
beds. However, I am directing
the department to review
current procedures and prepare
a plan to address any issues that
arise from that review.
FALL SESSION PREVIEW: MAINSTREET
INVESTMENTS, FAMILY CARE HEARINGS,
TASK FORCE ON ALZHEIMERS
While the biennial budget bill is
always the most important bill
considered by the Legislature,
many significant issues remain to
be discussed and debated by the
Legislature this fall and winter.
As all members are aware, an
Indiana real estate developer,
Continued on Pg. 8

On July 6, the Joint Finance

Committee concluded its actions
on the budget bill, voting 12-4 (on
party-line vote) to recommend the
bill for passage. Shortly thereafter, the
Senate passed the measure 18-15, the
Assembly concurred 52-46, and the
budget bill was presented to Governor
Walker on July 10.
Governor Scott Walker acted quickly
in signing Senate Bill 21 (2015 WI
Act 55), the biennial budget bill
into law. In fact, Governor Walker
Fall 2015 | CONTINUUM 7

Capitol Connection Continued

Mainstreet Investments, was seeking
introduction of an amendment to the
budget bill that would allow a special
exemption/carve out from Chapter
150, relating to the statewide nursing
facility bed limit and the moratorium
on constructing new skilled nursing
facilities. It has long been the law and
policy of Wisconsin that transfers of
skilled nursing facilities beds are very
limited and the construction of a
new facility is limited to the owner of
the licensed facility or the sale of all
licensed beds to a new owner, subject
to the approval of DHS. Mainstreet
Investments approached members
of the Joint Finance Committee
seeking to construct 26 transitional
care 100-bed facilities, promoting
something different from a nursing
home, but licensed as a nursing home
under Chapter 50 and DHS 132.
While an amendment was not
considered, it is clear Mainstreet

will continue its efforts to construct

transitional care facilities (nursing
homes) in Wisconsin since similar
efforts are being undertaken in
several other states.
FAMILY CARE REDESIGN
In his budget, Governor Walker
proposed sweeping changes to the
Family Care Program, including
IRIS and the Aging and Disability
Resource Centers. The Joint Finance
Committee deleted all of the statutory
changes recommended by the
Governor, but approved a number of
changes to the program which were
approved by the Legislature.
Since most citizens were surprised by
the Governors recommended changes
to Family Care, the Legislature directed
the Department of Health Services
(DHS) to consult with Family Care
stakeholders, and hold no less than 2
public hearings on changes to Family

Care. In response, DHS scheduled 8

public hearings in September to discuss
Family Care. The Department is also
required to include in its quarterly
Medicaid report (September 30 and
December 30, 2015) to the Joint
Finance Committee progress reports
on the development of proposed
changes to Family Care.
Over the next 6 to 8 months, DHS is
required to work on a waiver request
to submit to the Federal government
expanding Family Care statewide. If
approved, DHS is required to make
Family Care available statewide
by January 1, 2017, or later if
determined by DHS. The request
is required to include coverage
of both long-term care and acute
care services, including Medicare
funded services allowed by the
federal government from integrated
health agencies (IHAs), and to make
available consumer-directed options

under the long-term care program.

Prior to submitting any plan changes
to the federal government, the
Department is required to submit
a concept plan to the Joint Finance
Committee for review and approval
or disapproval no later than April 1,
2016. On July 1, DHS is directed to
release its waiver request for public
comment and submit the waiver
request to the federal government on
September 30, 2016. If the state plan
is approved and is consistent with the
plan approved by the Joint Finance
Committee, DHS can implement
changes to Family Care. If the waiver
is not approved, Family Care will
continue as in effect on July 1, 2015.

Americans have Alzheimers disease,

with two-thirds of those being
women. Its reportedly the sixth
leading cause of death in the country
and the only one in the top ten that
cant be prevented, slowed or cured.
With the increasing population of
older adults and increasing cost of
care, this task force will determine
ways to ensure future quality of care
while bending the cost curve of longterm care downward. The task force
members also will look to improve
and promote community-based
resources and raise awareness, as well
as address legal issues and determine
possible state participation in
treatment and research.

FALL FLOOR PERIOD

Recently, Speaker Vos announced
the creation of a Speakers Task
Force on Alzheimers and Dementia.
According to the Speakers press
release, roughly 5.3 million

Finally,
WHCA/WiCAL
will
continue to support Senate Bill
160/Assembly Bill 242, introduced
by Senator Sheila Harsdorf
(R-River Falls) and Representative
Kathy
Bernier
(R-Chippewa

Falls) to simplify rules relating to

maintenance and use standards
for oxygen equipment in skilled
nursing facilities. WHCA/WiCAL
have joined 28 other health care
providers in opposing Senate Bill
218/Assembly Bill 312, introduced
by Senator Frank Lasee (R-DePere)
and
Representative
Jeremy
Thiesfeldt (R-Fond du Lac) which
relate to prohibiting health providers
from requiring flu vaccinations.
While other issues may surface,
the fall session of the Wisconsin
Legislature is expected to be busy.
James McGinn
is WHCA/
WiCALs Director
of Government
Relations. He can
be reached at
[email protected]

Medical Supply Distribution

and

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8 CONTINUUM | www.whcawical.org

MULTIPLE SERVICES WITH A SINGLE FOCUS:

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MEDICARE & MEDICAID REIMBURSEMENT SERVICES

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ACCOUNTING & AUDITING SERVICES

FINANCIAL CONSULTING SERVICES

For more information, contact: Gary Johnsen
Phone: 262-789-9945 Fax: 262-782-8766
or visit our website at: www.jtcpas.com

Fall 2015 | CONTINUUM 9

Data Digest

How Data Influences Policy

The Role of Analytics and Statistics
By Kate Van Camp

ata use in policy decision

making has been growing with
the advent of more sophisticated data
systems and programs. As these new
technologies have been developed,
agencies have been calling on longterm care facilities to collect and
analyze data to evaluate performance
of health care entities to better inform
decision making at the macro level.
However, as data has proliferated, it
has also been important to understand
appropriate means to gather data,
accurately operationalize performance,
and understand the problems facing
the people who report data. While the
intent of data-driven policy decisions
are clear, it is often the execution of
this model that brings complexity and
nuance to understanding performance
and description.
In the past, policy changes in health
care settings may have been driven
by innovative ideas or simply hearsay
from others, but it was hard to
quantify the effectiveness of those
changes. In order to improve care
and optimize performance, skilled
nursing and assisted living facilities
need to become more data-driven.
Part of the task of modern day data
collection is that there is a lot of it.

Smart phones capture what apps

we buy, were asked for feedback
on shopping websites like Amazon.
com, and we receive surveys from
our credit card and cable companies.
With all of the data passing around,
its imperative to not only collect
meaningful data, but also to do so
in a time-efficient manner. Many
organizations already have the data
they need, but lack the foundational
practices and capabilities to get the
most out of these assets.
Research and data analysis first
requires asking pertinent questions:
Does having a higher staff
to resident ratio improve
quality of care?
How does training influence
safety?
How much money is being
spent on improving facilities
each year in Wisconsin?
How much, if any, overtime
causes changes in work
performance?
To allow for greater use and adherence
of capturing important data, the
questions themselves have to be clear
and targeted. These questions can arise
through discussions of the Board of

Directors, complaints from facilities

or employees or even residents. When
certain topics or discussions start
trending, theres usually a question
that can be answered.
The next step is determining if the
question can be asked with data
already available.
Do we already have this
information?
Does someone else have it?
If not, how can we get it?
Because of the numerous reporting
requirements and usefulness of data,
the majority of health information
we may be interested in exists
somewhere. Other times, surveys
can be a valuable source of data.
However, it is important to think
about the outcomes youre seeking
and all possible answers to a question
when designing a survey. If the
answers wont provide you with
meaningful data, the survey can
be a waste of time and make it less
likely that people will participate in
subsequent surveys.
Once youve gathered or located the
data needed, it can be analyzed any
number of ways. Several intensive
software programs exist for doing just
that but most people can effectively
answer research questions using
Microsoft Excel. From basics like
finding averages and creating charts
to regression analysis, Excel can be an
extremely helpful tool in visualizing
results.

The next phase is presenting the

findings to interested parties. At
this point an informed discussion
can help drive the decisions about
how to use the new information.
Within facilities, administrators can
use this information to push for
policy changes that are based on hard
evidence. At the association level,
this information may be used by a
lobbyist to educate legislators on
critical issues that exist in the sector.
In the modern era, facility leaders,
committee chairs, and legislators will
not be swayed or moved to act unless
they are presented with empirical
data. The knowledge and ability
exists to discover answers and leaders
must become data-driven to keep up
with best practices and policies that
are ever-changing.

In sum, the role of data in policy

decision while simply stated is a
complex evaluation and coordination
of many efforts. Information is
gathered through determining accurate
measurement,
asking
pertinent
questions, awareness of context/real
world/policy, and the understanding
of the multiple levels of organizations.
My job as Director of Research &
Data Analysis at WHCA/WiCAL is
to work with members to determine
what questions need answering,
if and how we can answer them,
and provide members with the
information that can maximize the
effectiveness of our Association.
Some of this work is done through the
WHCA/WiCAL Quality Assurance
Committee, which conducts regular
meetings. If you would like be

included on the distribution

of the QA Committee, and
a WHCA/WiCAL Member
Business Partner, please send
email to [email protected].

list
are
or
an

If you would like to know more about

how data influences policy or another
subject that is driven by empirical
data, please feel free to contact me.

Kate Van Camp

is the Director of
Research and Data
Analysis for the
Wisconsin Health
Care Association
and the Wisconsin
Center for Assisted Living. She can
be reached at [email protected].

USEFUL DATA SOURCES

Trend Tracker: LTC Trend Trackersis a web-based tool that
enables long-term and post-acute care providers to access
key information that can help their organization succeed. This
exclusive benefit for AHCA members, allows skilled nursing organizations to benchmark personal metrics to those of
their peers and examine ongoing quality improvement efforts. LTC Trend Tracker is AHCA members one-stop-shop
to gain timely information and valuable insight about their own performance as well as the entire professions.
Use Trend Tracker to:
Compare your facility to peers (within region, state, ownership type, etc.)

Access AHCA Quality Measures

Access AHCA Staffing Turnover and Retention Report

Design, save and schedule reports

Ltctrendtracker.com
Nursing Home Compare: These are the official datasets used on the Medicare.gov Nursing Home Compare
Websiteprovided by the Centers for Medicare & Medicaid Services.These data allow you to compare the quality of
care at every Medicare and Medicaid-certified nursing home in the country, including over 15,000 nationwide.
Use Nursing Home Compare for information regarding:
Deficiencies

Penalties

Ownership

State Averages

5 Star Ratings

Source: https://data.medicare.gov/data/nursing-home-compare

10 CONTINUUM | www.whcawical.org

Fall 2015 | CONTINUUM 11

Clinical Corner

2015-16 Influenza
Immunization Update

Pending Legislation, Risks and Resources

By Deb Martin, RN, BSN
The flu season has arrived have you
gotten your flu shot yet?

n long-term care organizations,

as well as acute care settings, it
is beneficial to increase vaccination
efforts for your staff and residents to
assist in creating a herd immunity
against the flu. Flu isnt just an
inconvenience; its a killer: its
estimated each year between 3,000
up to 49,000 people died due to fluassociated deaths in the United States.
Most of these flu-related deaths occur
in people age 65 and older.
According to the Centers for Disease
Control and Prevention, which
combines influenza and pneumonia,
it is listed as the eighth leading cause
of death: 56,979 in 2013, the most
recent year data is available.
PENDING LEGISLATION
In many states, including Wisconsin,
health care facilities require employees
to be vaccinated each season. This
summer, a bill was introduced that
would prohibit employers from
discriminating against employees,
volunteers, interns and contractors

who refuse to be vaccinated against

influenza. The legislation, Senate Bill
218, has been referred to the Senate
Committee on Health and Human
Services.
WHCA/WiCAL and many other
health care organizations have
forwarded a joint letter to the
Wisconsin State Legislators opposing
the bill. Seasonal flu vaccines
are designed to protect people
particularly vulnerable populations
like the frail elderly in LTC facilities
against the influenza viruses most
likely to spread and cause illness
during an upcoming flu season,
which typically peaks December
through February in the United
States. Although there is not a way
to know how severe each years flu
season will be, the CDC makes
annual recommendations based on
information gathered from around
the world.
DEVELOPING ANNUAL FLU VACCINES
Flu viruses are constantly changing.
In the United States for this flu
season, all of the 2015-16 influenza
vaccine will be made to protect

against the following three viruses:

an
A/California/7/2009
(H1N1)pdm09-like virus
an A/Switzerland/9715293/2013
(H3N2)-like virus
a B/Phuket/3073/2013-like
virus; this is a B/Yamagata
lineage virus
How do experts know which
influenza virus to vaccinate against?
Making that determination is a
multi-step, international process.
The first steps involve determining
which viruses pose the biggest risk
in any given year. More than 100
countries have national influenza
centers that conduct year-round
surveillance for influenza, the CDC
notes. The staff at these centers
receive and test many thousands of
influenza virus samples from patients
with suspected flu illness. The labs
send representative viruses from
those samples to five World Health
Organization (WHO) Collaborating
Centers for Reference and Research
on Influenza. Atlanta is the location
of the U.S center.
Next, each February, WHO staff
consult with experts to review
data generated by this worldwide
network of influenza labs. Based
on their findings, WHO makes
official
recommendations
for
the composition of the seasonal
influenza vaccine for the Northern
Hemisphere.

STAY UP-TO-DATE ON FLU INFO:

The Wisconsin Department of Health Services weekly influenza
https://www.dhs.wisconsin.gov/influenza/index.htm
U.S. Department of Health and Human Services Interactive Mapping Tool
http://www.hhs.gov/nvpo/flu-vaccination-map
Centers for Disease Control and Prevention weekly influenza surveillance report
http://www.cdc.gov/flu/weekly/fluviewinteractive.htm

12 CONTINUUM | www.whcawical.org

The next steps involve the production

of the vaccine. A committee under the
U.S. Food and Drug Administration
(FDA) the U.S. Vaccines and
Related Biological Products Advisory
Committee (VRBPAC) considers
the WHO recommendations and
makes a final decision about
composition of seasonal flu vaccine
for the United States.
This year, the vaccine strain
composition for the 2015-2016
influenza was announced on February
26 following the WHO Vaccine
Composition Meeting, which took
place in Geneva, Switzerland.
The following week, the VRBPAC
endorsed the WHO Northern
Hemisphere flu vaccine strain
selection for use in the production
of upcoming U.S. 2015-2016 flu
vaccines.
Vaccines that give protection
against three viruses are called

trivalent vaccines. Vaccines that

give protection against four viruses
are called quadrivalent vaccines.
Some of the 2015-2016 flu vaccine
is a quadrivalent vaccine and also
protects against an additional B virus
(B/Brisbane/60/2008-like virus). This
is a B/Victoria lineage virus.
Many people have asked in recent
years, why cant experts come up
with a more accurate estimate of flurelated deaths? The CDC notes that
states dont have to report individual
flu cases or adult flu-related deaths
to the CDC; seasonal influenza
is rarely listed as a cause of death
for those who die from flu-related
complications; and these deaths
often occur weeks after the initial
infection has aggravated an existing
condition or caused a person to
develop another.
GREATER RISK FOR THOSE 65 AND
OLDER: TAKE ACTION
Our immune systems weaken as we

age. Thats why people 65 years and

older are at greater risk of serious
complications from the flu compared
with young, healthy adults. Up to
90 percent of all flu-related deaths,
plus more than half of flu-related
hospitalizations, occur in people 65
or older, according to Flu.gov, a U.S.
Department of Health & Human
Services (HHS) site.
The best way to prevent the flu is with
a flu vaccine. CDC recommends that
everyone 6 months of age and older
get a seasonal flu vaccine each year
soon after it becomes available, and
by October if possible.
A flu vaccine protects against the flu
viruses that research indicates will be
most common during the upcoming
season. Immunity from vaccination
sets in after about two weeks.
People 65 years and older can choose
from two available flu shots a
regular dose flu vaccine and a newer
flu vaccine designed specifically for
people 65 and older with a higher
dose. This high dose vaccine contains
four times the amount of antigen as
the regular flu shot and is associated
with a stronger immune response
following vaccination.
The CDC provides a wealth of
influenza information that is easy
to understand and kept up to date.
Much of the information in this
article was taken from the site.

Deb Martin,
RN, BSN, is an
account executive
with CE Solutions,
WHCA/WiCALs
on-line education
partner. She can
be reached at 855874-6930, or via email at debm@
discovercesolutions.com

Fall 2015 | CONTINUUM 13

Cover Story

Building For The Long Term

Wisconsins LTC Facilities Invest $1 Billion in Their

Buildings to Provide Modern, Effective Therapy
By John J. Vander Meer

ver the last five years, Wisconsins

skilled nursing and assisted
living facilities have invested nearly
$1 billion in their buildings and
campuses to provide residents with
the best modern and effective longterm care and rehab therapy services.
Todays skilled nursing and assisted
living facilities provide all of the
amenities and cutting-edge therapy
options that residents and their
families have come to expect from a
long-term care community.

The increasing demand

for skilled nursing and
assisted living care
caused by the aging
Baby Boomer population
have made operators
scrutinize their longterm plans for providing
long-term care.
According to data from the
Wisconsin Department of Health
Services (DHS) skilled nursing and
assisted living facilities invested
$899,996,258 from 2010 to the
most recently reported facility
improvement costs this year.
These facility upgrades ensure that
Wisconsins frail elderly and disabled
citizens receive the most effective
care possible. It also guarantees
that people who need short-term

rehabilitation following a knee

replacement or a stroke can get highquality transitional care in one of
these facilities.
When someone is admitted into
one of Wisconsins skilled nursing
facilities, they could be there for
any number of short-term therapies.
But thats nothing new. Wisconsins
skilled nursing facilities have been
providing high-quality post-acute
rehabilitative care for more than 25
years. Post-acute care services occur
immediately after discharge from a
hospital and are aimed at returning
patients home within 30 days, and
often sooner.
Therapy Services in Wisconsins Skilled
Nursing Facilities Include:
State-of-the-Art Therapy Gyms,
Equipment and Aquatics
Cutting-Edge Physical Therapy

Innovative
Occupational
Therapy
Advanced Speech Language
Pathology
Respiratory Therapy and
Ventilator Care
Intravenous (IV) Treatment
Person-Centered Care and
Services

Despite the fact that Wisconsin

has the second-worst Medicaid
reimbursement system in the
country, and that most Family
Care providers have not received
reimbursement rate increases in
several years, Wisconsins long-term
care facilities provide some of the
highest quality care in the nation.
A report entitled Americas Health
Rankings released recently by the
UnitedHealth Foundation ranked
Wisconsin seventh in the nation
for overall health for seniors and

eighth in the nation for the quality

of skilled nursing care. Several other
studies, including a 2014 national
study conducted by Eljay, LLC
have confirmed the low Medicaid
reimbursement and high quality
measures of Wisconsins long-term
care facilities in recent years.
A LEAP OF FAITH
The increasing demand for skilled
nursing and assisted living care
caused by the aging Baby Boomer
population have made operators
scrutinize their long-term plans
for providing long-term care. In
Wisconsin, a DHS study found that
the over-85 population will increase
140 percent between 2010 and 2040.
As a result of this increasing need,
providers have still found new ways
to invest in their buildings despite
the states limited reimbursement.
Wisconsins providers
are committed to
providing the best
care in the best
environment, and we
are pretty much
taking a leap of
faith that our costs

are going to get covered, said Deb

Klatkiewicz, NHA at Park Manor,
Ltd. in Park Falls, WI. Unless
theres someone out there getting
younger on a daily basis, these are
services that people will continue to
need. Were going to have a lot
more people need all kinds of care.
The need for short-term care has
exploded in the last couple of years.
This summer, Park Manor, Ltd., a
100 licensed bed skilled nursing
facility broke ground on a $6
million renovation that will provide
the Price County community with
a facility that offers area residents
state-of-the-art therapy treatment
and equipment. The project will also
create numerous local construction
jobs.
Park Manor has an economic
impact on our area of over $12
million, Klatkiewicz said. Most of
the work on our building project has
been done at the local level. We
gave our general contractor a list of
every local contractor that we have
used over the years to give them the
opportunity to bid on the project.

The renovation, which is expected to

be completed sometime next year, will
feature 21 private rooms for short-term
rehabilitation and a modern therapy
gym where rehabilitation services
can be provided to both in-patient
residents and people living in the area.
The facility will also offer occupational,
physical and speech therapy.
Park Manor currently employs 165
staff members, 135 of whom are
employee owners of the Employee
Stock Ownership Plan Trust that owns
the facility. However, with the facility
expanding, Klatkiewicz said that the
number of employees in the areas of
direct care as well as maintenance and
house-keeping will likely increase as a
result of the addition of 20,000 more
square feet.
Dove HealthCare, which operates
several facilities in the Eau Claire/
Chippewa Falls area, also broke ground
on a new state-of-the-art nursing and
rehabilitation facility in Rice Lake
earlier this summer. The facility will
include 42 private rooms, 4 semiprivate rooms, two deluxe spas with
fireplaces, and a 2,500 square foot
rehab gym.
Dove Healthcare
Rice Lake will
be Barron Countys
rehabilitation
destination, with all
of the latest amenities
and services close to
home, said Jeremy
Kiley,
Regional
Director of Operations for Dove. It
is an expansion of our Transitions
Rehabilitationprogram, where
individuals spend an average of three
to four weeks in post-hospitalization
care in route to home. By investing
heavily in our staff, therapy gyms,
and equipment, we ensure our
patients receive the most advanced
and progressive treatment.
Continued on Pg. 20

14 CONTINUUM | www.whcawical.org

Fall 2015 | CONTINUUM 15

Stakeholder Spotlight

CARES Online Training and

Alzheimers Association
essentiALZ Certification
Personal Connection to Alzheimers Leads
to Development of Online Dementia Care
Training and Certification Program
By John Hobday

care training programs in conjunction

with the Alzheimers Association.
Its called CARES, and the training
programs are for both professional care
staff as well as family members.
They include:
Integrated professional programs
on dementia basics
Advanced topics
Dementia-related behavior
Activities of daily living
End-of-life dementia care
Dementia care strategies for
families in a home setting
The programs incorporate evidencebased care strategies based upon
a comprehensive review of the
academic literature published by the
Alzheimers Association.

he story is hardly unique. A

woman in her late-80s begins to
decline with memory issues, stops some of
her favorite activities like cooking, sewing,
and gardening, and eventually forgets
to eat or drink for days. Her hygiene
suffers, she seems confused and uneasy at
family events, no longer recognizes some
family members or neighbors, and even
becomes incontinent. It is at that point
that the family cannot find a solution to
the growing care needs and decides that it
is in the best interest of everyone for her
to move into a nursing home. Because
the symptoms have been ignored for so
long, she is placed directly onto a special
care unit.

I remember thinking at
one point, There are
national experts that I
have access to that other
families living right
across the street would
never have access to.

That was my grandmother, Therese

Morzinski. As it happens, I had
started a small educational consulting
company a few years earlier and
worked on an Alzheimers disease
project with the Department of
Veterans Affairs. As my grandmother
declined, I began to recognize some
of the signs as they were occurring. It
was quite surreal. I was able to help
my mom and her siblings through
some difficult decisions, as best I
could. I also facilitated conversations
with some of the Alzheimers experts
I had met during my work with the
VA. I remember thinking at one
point, There are national experts
that I have access to that other
families living right across the street
would never have access to. Even
with access to these experts, our
family still went through so much
sadness, loss, and pain. I decided I
wanted to use my small business to
do something about that.
My small business, HealthCare
Interactive, has now spent the past decade
developing a suite of online dementia

The programs also include an

overarching framework to care called
the CARES Approach. This fivestep protocol is easy for staff and
families to learn and remember, and
is the what to do with anyone with
dementia, at any level of decline, and
in any care situation. CARES is an
acronym that stands for C-Connect
with the Person; A-Assess Behavior;
R-Respond Behavior; E-Evaluation
What Works; and S-Share with
Others. The programs introduce the
CARES Approach and then integrate
it into all topics of discussion. For
example, when talking about pain, or
dressing, or wandering, it is all done
within the context of CARES and
what you can do in any situation.
Another aspect that sets the CARES
training apart from others in the
marketplace is the real video footage.
Twenty years ago when I worked
on the project for the VA, someone
suggested hiring actors to play the
roles of people with dementia and
family members. It seemed really
counter intuitive to do this if you
wanted to capture actual dementia

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Continued on Pg. 18
16 CONTINUUM | www.whcawical.org

Fall 2015 | CONTINUUM 17

Stakeholder Spotlight Continued

care in progress. Instead, we decided
to get consent from families and film
only real people with dementia, real
families, and real staff members. Fast
forward 20 years, and our company
has filmed only real people in care
settings like skilled nursing facilities,
assisted living facilities, hospice
centers, hospitals, and individual
homes in 18 states and 2 countries.
Filming real people is definitely more
difficult especially when you are
filming someone with dementia. But
it makes for one of the most authentic
training experiences possible.

For More Information on

CARES online training and
essentiALZ Certification:
www.mcinteractive.com/cares
and www.alz.org/essentiALZ.
For questions about our CARES
programs, Alzheimers Association
essentiALZ certification, or
which programs are right for
your organization to meet state
demential training requirements,
call us at 952-928-7722.
The CARES programs even include
before-and-after video scenarios
using the CARES Approach. We
film a care scenario, which usually
ends up being less than ideal care.
Then we film again using the
CARES Approach. The difference is
stunning and all has to do with the
C-Connect with the Person and
A-Assess Behavior steps. These are
the same care situations with the
same caregivers with the same real
person with dementia or Alzheimers
disease. The only take away staff and
families can have with this approach
is to say, Oh my gosh, I have
18 CONTINUUM | www.whcawical.org

something to do with the behavior of

the person I am caring for. They are
not being difficult, and they are not
being challenging. In most cases,
we have found that they are simply
responding to the person caring for
them. If you change your approach,
you change the persons response
and, in fact, the entire care outcome.
Beginning in late 2011, the
HealthCare
Interactive
team
worked to integrate our five
CARES training programs with the
Alzheimers Association essentiALZ
certification program. EssentiALZ
evaluates knowledge of the evidencebased practice strategies from the
Alzheimers Association practice
recommendations that are integrated
into CARES. Anyone completing
an eligible CARES program can
take a certification exam with the
Alzheimers Association. If they pass,
they can list the certification on their
resume and display their certificate
within their work organization.
CARES online dementia care
training and essentiALZ certification
from the Alzheimers Association has
been used nationally and in over 50
countries worldwide.

CARES online training and Alzheimers

Association essentiALZ certification are
recommended by the Centers for Medicare
and Medicaid Services (CMS), and the
Wisconsin Health Care Association
(WHCA). The American Health Care
Association (AHCA) and the National
Center for Assisted Living (NCAL)
recommend CARES to help reduce the
off-label use of antipsychotics.

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Fall 2015 | CONTINUUM 19

Cover Story Continued

With an opening expected in the
summer of next year, the new
Medicare- and Medicaid-certified
facility will employ about 100
part-time and full-time positions,
including
nursing,
therapy,
nutritional services, recreation, and
environmental services.
Michael Schanke,
Board
President
of the Wisconsin
Health
Care
Association,
has
moved forward with
a renovation project
at his Menasha
facility as well.
The
$4.5
million
building
renovation and repurposing project
at Oakridge Gardens will relocate
and upgrade the rehabilitation area
to better accommodate short-term,
post-acute patients. The facility will
include private patient rooms, a
dining room dedicated to the rehab
area, and community space for
patients to socialize.

The building projects that

Wisconsins long-term care facilities
have undertaken in recent years are
not limited to any ownership type
or region of the state, Schanke said.
The staff at Oakridge Gardens and
at long-term care facilities around
the State of Wisconsin are dedicated
to ensuring that their residents have
best quality care.
THE MULTIPLIER EFFECT
The flow of dollars spent by
LTC facilities within the states
economy expands dramatically as
the money passes into the hands of
employees and local businesses and
organizations through which the
facility and its employees purchase
goods and services. The firms within
the goods and service chain, in turn,
pay wages and salaries and themselves
purchase goods and services further
along the chain.
Kiley and Klatkiewicz say the
significant investment they are making
in their buildings not only enable
them to continue providing great

care, but collectively has a significant

impact on the states economy.

Providing quality rehab services to patients

and long term care facilities since 1977

Dennis Winters, the economist from

NorthStar Economics, Inc., who
authored a report on the economic
impact of Wisconsins skilled nursing
facilities, said the states SNFs alone
already have a greater impact on
employment than that of the paper,
plastics, real estate, and accommodations
industries in Wisconsin.
The NorthStar 2013 report found that
the Wisconsins skilled nursing facilities:
Contribute over $5.5 billion
to the states economy
Employ 52,306 workers, an
equivalent of over 37,137 fulltime equivalent positions, and
create another 27,316 jobs
Spend almost $2.9 billion on
payroll and good and services
in Wisconsin
Generate over $250 million
in state income, sales, and
property taxes

Our Mission is to provide rehabilitation

and related services in an atmosphere
of integrity, trust and compassion,
glorifying God in all that we do.
MJ Care
Values

Respect n Integrity
Innovation n Service Excellence
Quality n Education

MJCare.com

EST D 1977

Professional Rehabilitation
& Health Services

Experience Matters

Jane Beisser, OTR, Vice President

2448 S. 102nd Street
Milwaukee, Wisconsin 53227
(414) 329-2429
[email protected]

The jobs available in long-term

Continued on Pg. 24

SKILLED NURSING AND ASSISTED LIVING FACILITY CONSTRUCTION PROJECTS APPROVED BY DHS FROM 2010 THROUGH JUNE 2015
Year

Nursing Homes

Assisted Living

Total

2010

$124,810,652.43

$37,902,382.44

$162,713,034.87

2011

$100,328,047.70

$39,229,110.13

$139,557,157.83

2012

$82,508,163.80

$69,407,664.00

$151,915,827.80

2013

$58,615,883.80

$77,695,777.20

$136,311,661.00

2014

$77,912,294.00

$116,571,382.60

$194,483,676.60

Subtotal

$444,175,041.73

$340,806,316.37

$784,981,358.10

Five-year Avg.

$88,835,008.35

$68,161,263.27

$156,996,271.62

125 S. Thompson Rd. | Sun Prairie, WI 53590

Phone: (608) 837-8002 | Fax: (608) 837-8005

2015 ytd

$58,307,700.20

$56,707,199.92

$115,014,900.12

www.oconnellpharmacylongtermcare.com

Total

$502,482,741.93

$397,513,516.29

$899,996,258.22

Going the extra mile is our way of doing business!

Serving Facilities in South Central WI

Source: Department of Health Services data provided to the Wisconsin Health Care Association and LeadingAge Wisconsin, July 2015

20 CONTINUUM | www.whcawical.org

Fall 2015 | CONTINUUM 21

LTC Legal Letter

Staffing Agency Workers:

Dont Assume You Are
Avoiding Employment Law
Requirements And Risks
By Brian Purtell and Scott Paler

any long-term care providers are

finding themselves facing acute
difficulties in recruiting and retaining
staff qualified. Not surprisingly, many
are looking to third-party agencies to
address their staffing gaps as they seek
to fill open positions. Helpful? Yes.
Worry free? No.
Many providers erroneously think
that since temporary staffing workers
are not their direct employees they
do not assume any employment or
labor law responsibilities as to these
individuals. Unfortunately, this is
not true, as in some circumstances
providers can be considered joint
employers of temporary workers
which may expose the provider
to responsibilities towards the
contracted personnel.

The single most important

step that a provider can
take is to get the staffing
contract right.
The single most important step that
a provider can take to lessen its risks
as to temporary workers is to get the
staffing contract right. Dont ignore
it! Dont skim over it! Dont read
through everything but the difficultto-understand legal stuff.

22 CONTINUUM | www.whcawical.org

What terms should you pay particular

attention to? Here are a few:
TERMINATION OF CONTRACT:
What does the contract say about
your ability to exit the contract? Are
you required to provide 60 days
written notice? Or 6 months notice?
Or can you terminate at will. The
more flexibility you have to exit,
the more you can press the staffing
agency to meet your needs.
INDEMNIFICATION:
It is not unusual for temporary workers
to sue for alleged discrimination, lack
of overtime payments, harassment,
and other customary employment
concerns. When they sue, do they
sue just the staffing company (their
supposed employer), or do they sue
the staffing company and the provider?
Usually both. Plaintiffs attorneys not
surprisingly believe that two deep
pockets are usually better than one.
Moreover, it is typically much more
possible to deem the provider a joint
employer than providers realize.
To reduce risk, consider negotiating on
indemnification clause with the staffing
company under which the staffing
company agrees to reimburse you for
any damage award and costs under
certain or all circumstances in which a
worker or a third-party brings an action.
The broader the indemnification, the
better. It is important to negotiate
wisely on this issue.

DIVISION OF LABOR ON TRADITIONAL

EMPLOYMENT ISSUES:
Which entity is going to do what?
I-9 verification? Issue paychecks?
Handle employee investigations?
Clarity it critical. But beware, as the
contractual description of which
entity is doing what can be used by
plaintiff s counsel to help establish
joint employment. For example, it
can be used to show the provider
directs and controls workers on
day-to-day assignments, a hallmark
of joint employment. If the staffing
company is not pledging to protect
you through an indemnification
clause, careful attention to this area
is particularly important.
COVENANTS NOT TO COMPETE:
Some staffing contracts state that
providers will not solicit workers for
at least six months or a year after an
assignment ends. This means that you
cannot just hire the worker if you wish.
Consider negotiating a reduction in
the amount of time that you have to
wait or the buy-out amount.

SCREENING
FOR
WISCONSIN
CAREGIVER PURPOSES/EXCLUSION:
As providers have obligations to assure
that individuals providing services
are properly screened, including
certain prohibitions about allowing
individuals to serve in a caregiver
capacity, it is essential that the
agreement contain a clear explanation
as to who bears responsibility for the
screening of individuals to be placed
within the facility.
Typically, this would be an expectation
on the agency that is the employer
of record; however, providers should
assure that the screening include,
at a minimum, compliance with
Wisconsins caregiver background
check law; initial and ongoing
checking the assure the individual is
not an excluded individual for whom
billing cannot be made to a Medicare
or Medicaid program for their services;

as well as assuring the currency and

accuracy of the individuals license or
related credentials.
Screening
requirements
should
address not only the need for an
initial screening, but also the need for
ongoing checks. They should take into
account procedures required under
applicable background screening laws,
such as the Fair Credit Reporting
Act (FCRA) as well. Lawsuits
attacking entities for failing to follow
background screening procedural
requirements are on the rise.
Note: This article has been written by
Brian Purtell and Scott Paler, Partners
at DeWitt Ross & Stevens S.C. It
should not be considered legal advice,
but instead general information. For
legal advice on specific contracts,
contractual issues or business
relationships, please contact counsel.

Brian Purtell is a
shareholder at the
Madison office of
DeWitt Ross &
Stevens, S.C. He also
serves at the Director
of Legal Services
for the Wisconsin
Health Care Association and the
Wisconsin Center for Assisted Living
and the Executive Director of the
Wisconsin Center for Assisted Living.
He can be reached at (608) 252-9366
and [email protected].
Scott Paler is a
shareholder at the
Madison office of
DeWitt Ross &
Stevens, S.C. and
Chair of the Labor
and
Employment
Practice Group.He
can be reached at (608) 252-9213
and [email protected].

LICENSURE CONFIRMATION:
Contractual clarity with regards
to assuring personnel have current
and appropriate licenses and/or
credentials is critical. As providers
are often billing for the services of
specific licensed positions, a lapse in
an individuals license, or deception as
to qualifications, can place a provider
in a position of, at a minimum,
having to make repayment for
services billed. Stating to an auditor
that they were not my employee
will likely not be a defense to the
overall obligation that their services
are provided by qualified personnel.
Independent verification by the
provider, regardless of contractual
terms, should be considered.

Fall 2015 | CONTINUUM 23

Cover Story Continued

care are relatively recession-proof
and cannot be outsourced; they
offer readily accessible employment
and career ladders for individuals,
displaced workers and students. At
the same time, these jobs provide
essential services for the states frail
and elderly citizens.
INCREASING SUPPLY, MODERN AMENITIES
Winters said that based on the
construction projects approved by
DHS for the first half of 2015, it
appears that the economic impact
for the current year will surpass the
average of the past five years.
A 2015 report by NorthStar
Economics, Inc., authored by
Winters, based on the data obtained
from DHS, and commissioned by
WHCA/WiCAL and LeadingAge
Wisconsin found that the five-year
construction spending average for
Wisconsins skilled nursing and
assisted living facilities is $157
million. This spending translates into
the creation of a significant number
of jobs every year.
Winters, who also serves as the
Chief Economist of the Wisconsin
Department
of
Workforce
Development, stated that an
established jobs multiplier produces
a calculated estimate that over the
five-year period covered in the data,

skilled nursing and assisted living

facility construction projects:
Created
over
16,635
construction-related
jobs,
averaging 3,327 jobs/year
Generated new tax revenues
of $65 million
Yielded $13 million in tax
revenues per year
In fact, Klatkiewicz and other
providers say that the amount of
money that providers invest in their
facilities is almost certainly more
than the numbers reported to the
Wisconsin Department of Health
Services because they dont include
many of the investments facilities
make in furnishings and other
elements that create a homelike
environment, one of the many things
on which providers are surveyed.
In our experience
over the past few
years, there has most
definitely been an
increase in skilled
nursing and assisted
living
projects,
said Wayne A. Dau,
Architect with River
Valley Architects, Inc., a design firm
based in Chippewa Falls, WI. There
seems to be a close balance between
(skilled nursing and assisted living
facilities) except for the fact that

the SNF project tends to be new

replacement facilities, while the AL
projects are more additions to existing
facilities or converting existing SNF
areas to AL.
The senior housing
construction market
has
become
a
significant market in
Wisconsin.We have
seen skilled nursing,
therapy
facilities,
hospice care and
other senior housing
type projects boom as of late,said
Jason Plante Vice President of Market
& Johnson, an Eau Claire-based
construction firm. Currently we have
over $75 million in senior housing
projects under construction which is
our highest amount in recent history.
Dau and Plante said they have seen
numerous trends in long-term care
facility construction that are designed
and proven to lead to improved
patient and resident outcomes.
The integration of natural light into
the center core of the resident living
spaces has become a must, Dau said.
With the numerous studies available
now which describe both the physical
and mental benefits of sunlight, and
our bodies need to set its daily clock,
why wouldnt you strive to achieve the

TOTAL ECONOMIC IMPACT OF WISCONSINS SKILLED NURSING FACILITIES

Category

Direct Impact

Economic Multiplier

Economic Contribution

Payroll net Taxes and Leakages

$1,016,611,222

2.5

$2,381,286,264

Purchases of Good & Services

$1,298,178,768

2.3

$3,000,936,325

Wisconsin Personal Income Tax

$44,861,493

2.8

$127,110,555

Property Taxes

$12,986,880

2.8

$36,797,026

TOTAL

$ 2,372,638,363

$5,546,130,170

Jobs Creation of Wisconsins Skilled Nursing Facilities

Job Creator

Head Count

FTE Equivalent

Total Number of Nursing Home Workers

52,306

37,137

Jobs-to-Jobs additions

14,272

Nursing Homes Business Spending-to-Jobs

13,044

Total FTE Jobs Created

64,453

Source: Economic Analysis: Nursing Homes Contribution to Wisconsins Economy & Employment,
NorthStar Economics. March 2013.

presence of natural light? As designers

we have integrated this philosophy of
design into all project types.
Dau said over the past several years
there has been an obvious increase
in resident-orientated design, and
less concentration on staff-orientated
design, which involves a design
concept based on giving the resident
the greatest freedom of choice.
Plante said most of the newer facilities
center around private rooms with nice
ensuite bathrooms, state-of-the-art
spa rooms, community-based designs
or pods that feature smaller more
intimate dining and living areas.
Almost all the facilities are designed
around a more homelike atmosphere
for the residences including private
bed and bathrooms, Plante said.As

we plan or lay these areas out, much

of the conversation is focused on how
care providers can most efficiently
provide services to the resident with
minimal disruptions.
MAINSTREET INVESTMENTS
Earlier this year, an Indiana-based real
estate development company sought
an amendment to the 2015-17 State
Budget that would have lifted the states
nursing facility bed moratorium that has
been in place for decades by creating a
care category called Transitional Care.
Mainstreet Investments, the company
seeking the special exemption, was
looking to build 26 transitional care
100-bed facilities that would have been
regulated just like nursing facilities, but
would have allowed the facilities to
cherry-pick Medicare and private-pay
residents, and ignore Wisconsins poor

frail elderly and disabled residents, who

depend on Medicaid as their source of
payment for health care.
While lobbyists for Mainstreet
Investments proposal have pointed
to flashy numbers of economic
generation their proposal would
redirect the existing economic impact
that Wisconsins skilled nursing
facilities already generate.
With nearly 20 percent of Wisconsins
skilled nursing beds over 6,670
currently unoccupied (about
76 buildings worth of available
capacity), Wisconsins skilled nursing
facility operators have uniformly
expressed significant opposition
to such an effort. If adopted, this
proposal would undermine existing
skilled nursing facilities and make it
more difficult for providers to recruit
and retain front-line caregivers.
I would warn against out of state
developers, who in the name of
economic development, are trying
to convince you that Wisconsins
provider community needs them in
this state, Kiley said. Our results
come from a long-term commitment
to the communities we serve. We
work hand-in-hand with our acute
care partners and we ensure that
all residents receive the care they
deserve. Legislators should invest in
those providers that are proven high
performers already operating in the
state. They did this a few years back
by providing incentives to build new
facilities through the reimbursement
formula. That is a more prudent
approach than trusting outside
Continued on Pg. 26

Source: 2013 NorthStar Economics Report, Nursing Homes Contribution To Wisconsins Economy & Employment

24 CONTINUUM | www.whcawical.org

Fall 2015 | CONTINUUM 25

Cover Story Continued

entities who develop and look for
management contracts.
Kiley and many other providers
believe that allowing real estate
developers to build so many new
facilities will flood the LTC facility
market and force many long-standing
care communities out of business.
This wouldnt create new jobs, but
would simply move jobs from one
facility to another.
During a luncheon
newsmaker interview
series hosted by
Wisconsin
Health
News in July, Wisconsin
Department of Health
Services Secretary Kitty
Rhoades stated that
there is no need for an
additional care category for Transitional
Care as is being sought by Mainstreet
Investments.
Rhoades further stated that Wisconsins
LTC providers have been doing
transitional rehabilitative care for years
and there are only a few counties in
the state where occupancy is even
close to 90 percent indicating that
while there is demand, it is nowhere
near the threshold required to lift the
moratorium on adding licensed beds.

MANDATORY REPORTER DEMENTIA TRAINING ORIENTATION CNA SERIES NURSING COURSES

STAFFING CRISIS
The real problem isnt the supply
of beds, providers say, its the lack
of supply of frontline caregivers.
Increasingly, because of the states low
Medicaid reimbursement rate and
the salary prospective employees can
secure with other companies, such as
McDonalds, Wal-Mart and Kwik Trip,
frontline caregivers are increasingly
difficult to recruit and retain.
The system is under-funded now
and were expected to provide more
and more care, with more and more
regulations, Klatkiewcz said. This
is an important resource for every
community. We could hire 4-5
employees right now but the people
are just not available.
According to 2013 cost reports, the
most recently analyzed, Medicaid
is the source of payment for 65
percent of the individuals receiving
care in Wisconsin nursing facilities.
As labor constitutes over 75 percent
of resident care costs, the level
of staffing, wages, and employee
benefits, the resources a facility has is
dependent on the level of Medicaid
reimbursement it receives from the
state. Moreover, the inflexibility of
Medicaid as a funding source makes
attracting the necessary staffing,
let alone moving forward with a

Tax Revenue Generation of Wisconsins Skilled Nursing Facilities

Tax Revenue Generation

Tax Revenue

Employee Tax Revenue

$141,411,212

Staff Generated Jobs Tax Revenue

$53,548,446

Nursing Homes Taxes and Fees

$12,896,880

Nursing Home Spending Generated Jobs Tax Revenue

$48,938,768

Total State Tax Revenue Generated

$ 256,885,306

Source: Economic Analysis: Nursing Homes Contribution to Wisconsins Economy & Employment,
NorthStar Economics. March 2013.

26 CONTINUUM | www.whcawical.org

building project, very difficult.

The biggest concern for the aging
Baby Boomer population is the
caregiver staffing crisis. We need a
reimbursement formula that will
allow long-term care providers
to compete in the health care
marketplace, Kiley said. We are
seeing the wage gap between LTC
and acute grow at an alarming rate.
Additionally, other industries are
paying wages that are making it
almost impossible for us bring new
CNAs into the workplace. This crisis
needs to be addressed through the
reimbursement system soon before
this statewide staffing shortage stifles
all the progress we made as a provider
community.
Providers like Kiley and Klatkiewcz
say that an investment of targeted
Medicaid funding to frontline
caregivers will allow facilities to
provide deserved wage increases to
their staff, while at the same time
improving the quality of life of those
who receive and provide care.
Many providers are taking
substantial risk to provide high
quality services in the communities
they serve, Kiley said. We care
about our reputation and our
results. We are not developers who
are in this for the quick buck.
We are willing to do whatever is
necessary to prepare for the future
and the expectations that will come
from the aging Baby Boomers.
John J. Vander Meer
is the Director of
Communications
for the Wisconsin
Health Care
Association and the
Wisconsin Center
for Assisted Living.
He can be reached at
[email protected].

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