Information Letters

License Capacity in Adult Day Care (ADC) Day Activity and Health Services (DAHS) Facilities – DADS reminds providers that all licensed ADC facilities participating in the DAHS program must not exceed their licensed capacity. Download the letter for more information.

Waiver Survey and Certification (WS&C) Process to Initiate Alternative Services for Individuals Whose Health, Safety and Welfare Are at Risk – DADS will coordinate with the local Mental Retardation Authorities to initiate alternative services for all involved individuals if DADS WS&C staff is faced with situations where the health, safety, or welfare of an individual receiving Home and Community-based Services is at substantial risk due to the actions or inaction of the provider, among other things. Download the two-page letter for details.

Forms 3618 Discharge Required for Inpatient Hospital Stays – DADS reminds Nursing Facilities of Texas Administrative Code (TAC) requirements as stated in TAC §19.2615, Resident Transaction Notice. Download the two-page letter.

Federal Survey Letters

Impact of Nursing Shortage on Hospice – DADS issued a memo that addresses the impact of the current nursing shortage on access to hospice care. Download the three-page memo for more information.

Survey and Certification Issues Related to Hurricane Ike – DADS issued a two-page memo about the impact of Hurricane Ike in the region, the president’s national emergency declaration in certain counties in Texas and Louisiana, and the Centers for Medicare Medicaid Services’s authorization to waive or modify provider requirements. Download the memo.

Survey and Certification Issues Related to Hurricane Gustav – This letter contains the same information as the previous one, but in relation to Hurricane Gustav. Attached are Survey and Certification Declared Public Health Emergency frequently asked questions. Download the 41-page memo and attachment.

• Survey About Vehicles Used for Transportation of Individuals

DADS requested that Assisted Living Facilities (ALFs) participate in a survey of providers regarding vehicles used to provide transportation of individuals enrolled in DADS programs. The deadline is October 1, 2008. Here is a direct link to the survey. Download the letter for more information.

• Regulatory Compliance Issues Related to Hurricane Ike

DADS informed Intermediate Care Facilities for Persons with Mental Retardation or a Related Condition, Nursing Facilities (NFs), ALFs, Adult Day Care Providers, and Home and Community Support Services Agencies of its flexibility in regulatory and enforcement programs to accommodate the emergency needs of consumers and providers in the wake of Hurricane Ike. Download the two-page letter for more information.

• Consumer Directed Services (CDS) and Dental Service Adjustments

DADS informed Deaf Blind with Multiple Disabilities Providers (DBMD) and CDS Agencies that effective October 1, 2008, the DBMD program will implement the new Financial Management Services reimbursement methodology adopted by the Texas Health and Human Services Commission for the CDS option. Download the two-page letter for more information.

• Requesting Providers to Complete Online Survey Relating to Transportation Practices

DADS requests that Home and Community-based Services Providers and Texas Home Living Program Providers complete an online survey relating to transportation practices. The deadline is October 3, 2008. View the survey here, and download the letter here.

• NF Enhanced Direct Care Staff Rate — State Fiscal Year 2009 Optional Worksheets Incorporating Both TILEs and RUGs

DADS notified NF providers that it posted Rate Analysis website optional worksheets for use in estimating compliance with Staffing and Spending Requirements under the Enhanced Direct Care Staff Rate for SFY 2009. Download the two-page letter for more information.

Here is its projected path:

In the Gulf of Mexico, Tropical depression Five took shape last night, and has been upgraded to Tropical Storm Erin at 10 am CT moving northwest toward the southeastern Texas Coast.

Conditions appear favorable for Tropical Storm Erin to be a flooding rain threat into Friday night.

The current forecast track brings this system into the southern Texas Coast on Thursday, but the impacts will be felt along all of the Texas Coast, from Brownsville, through Corpus Christi and Houston, to Lake Charles, LA.

Tropical Storm Dean is a potential threat:

Meanwhile, our second area of concern, Tropical Storm Dean (60 mph), continues to move quickly west in the Atlantic.

Dean is forecast to become a hurricane by Thursday night or early Friday, and should be threatening the Lesser Antilles as early as Friday. From there, Dean should continue west-northwestward into the Caribbean.

It is too early to tell what, if any, impacts Dean will have on the United States.

Here is Dean’s potential path:

I spoke with someone at DADS today. By next Monday, the Governor’s Division of Emergency Management should be tracking Tropical Storm Dean (which may be a hurricane by then), so keep up with information from that site. Also, providers should be checking with Regional Offices for regulatory questions about evacuations, etc.

In a provider letter dated June 1, 2007, DADS is notifying Texas long-term care facilities that it will be conducting a hurricane preparedness exercise “involving local, state, federal, and private sector partners.” DADS is requesting that you update your number of vacancies in the Facility Inventory, Vacancy and Evacuation Status application (FIVES) on a daily basis.

FIVES can be accessed here.. The provider letter can be accessed here.

Topics to be presented include aging in place, emergency preparedness, and medication management. For locations and times, you may download the letter here.

DADS reminded nursing facilities (in a May 15 letter) about the need to notify Medicaid clients of increases in their monthly applied income amounts — which resulted from a cost of living adjustment to Social Security benefits in January — pursuant to federal regulations and the state administrative code. You may download the letter here for more information.

Texas providers (and all residents) should visit the disaster preparation resource page at TexasOnline to stay up-to-date on current news and tips. You’ll find links to organizations and agencies that specialize in preparing for disasters, including the Federal Emergency Management Agency and American Red Cross.

There are links to state and local government agencies and organizations, and advice on how to avoid charity scams. For more information, visit the Disaster Recovery Resources page at the Texas Cooperative Extension Disaster Education Network.

Last week I linked to the Inspector General’s report on nursing home emergency preparedness and response. Click on this link to read the post and download the report.

The

OIG reviewed 20 nursing homes for the study. According to the report, 94 percent of nursing homes met government guidelines for emergency plans, and 80 percent met guidelines for sufficient emergency training in 2004-2005.

However, nursing homes didn’t always follow the plans. For example, 5 of the 20 deviated from their emergency plans for various reasons. In some cases, there was a lack of coordination between state and local emergency entities.

OIG recommended that the Centers for Medicare and Medicaid Services strengthen certification standards for nursing home emergency plans by developing a “core set of required elements” and encourage better communication between government entities and nursing homes.

For more information about the report, see “Study of Nursing Home Disasters in Last Year’s Hurricanes Recommends Changes.”

You may download the 48-page report here (PDF).

The 211 system is a telephone number that connects callers to local health and human services agencies. People looking for social service assistance for food, housing, education, legal help, child care, physical and mental health, financial support, transportation, or emergencies can dial 2-1-1 and speak with trained professionals who will refer them to the appropriate agencies.

The Texas Health and Human Services Commission, Texas Alliance of Information and Referral Systems, and various community-based organizations collaborate to provide this service.

DADS requires that HCSSAs and ADCs have written plans for disaster preparedness, including triage, evacuation, sheltering, etc. You may download the letter here.

The decision to stay or flee in the event of a hurricane can be difficult even for the able-bodied. But as the evacuations for hurricanes Katrina and Rita showed this year, the decisions made at nursing homes more likely could be a matter of life and death. Several nursing home patients died in Louisiana because they were not evacuated before Katrina hit, and in one case the owners of a home were charged with negligent homicide. On the other hand, several nursing home patients perished because they were evacuated; they died in transit.

In the aftermath of Hurricane Katrina, Senator Chuck Grassley asked the Office of Inspector General of the U.S. Department of Health and Human Services to investigate nursing home deaths last month. I blogged about it here. No doubt deaths resulting from Hurricane Wilma will spark more investigations.

Hurricane Wilma struck the Florida mainland this morning.

Honore: And Mr. Mayor, let’s go back, because I can see right now, we’re setting this up as he said, he said, we said. All right? We are not going to go, by order of the mayor and the governor, and open the convention center for people to come in. There are buses there. Is that clear to you? Buses parked. There are 4,000 troops there. People come, they get on a bus, they get on a truck, they move on. Is that clear? Is that clear to the public?

Female reporter: Where do they move on…

Honore: That’s not your business.

Male reporter: But General, that didn’t work the first time…

Honore: Wait a minute. It didn’t work the first time. This ain’t the first time. Okay? If…we don’t control Rita, you understand? So there are a lot of pieces of it that’s going to be worked out. You got good public servants working through it. Let’s get a little trust here, because you’re starting to act like this is your problem. You are carrying the message, okay? What we’re going to do is have the buses staged. The initial place is at the convention center. We’re not going to announce other places at this time, until we get a plan set, and we’ll let people know where those locations are, through the government, and through public announcements. Right now, to handle the number of people that want to leave, we’ve got the capacity. You will come to the convention center. There are soldiers there from the 82nd Airborne, and from the Louisiana National Guard. People will be told to get on the bus, and we will take care of them. And where they go will be dependent on the capacity in this state. We’ve got our communications up. And we’ll tell them where to go. And when they get there, they’ll be able to get a chance, an opportunity to get registered, and so they can let their families know where they are. But don’t start panic here. Okay? We’ve got a location. It is in the front of the convention center, and that’s where we will use to migrate people from it, into the system.

Male reporter: General Honore, we were told that Berman Stadium on the west bank would be another staging area…

Honore: Not to my knowledge. Again, the current place, I just told you one time, is the convention center. Once we complete the plan with the mayor, and is approved by the governor, then we’ll start that in the next 12-24 hours. And we understand that there’s a problem in getting communications out. That’s where we need your help. But let’s not confuse the questions with the answers. Buses at the convention center will move our citizens, for whom we have sworn that we will support and defend…and we’ll move them on. Let’s not get stuck on the last storm. You’re asking last storm questions for people who are concerned about the future storm. Don’t get stuck on stupid, reporters. We are moving forward. And don’t confuse the people please. You are part of the public message. So help us get the message straight. And if you don’t understand, maybe you’ll confuse it to the people. That’s why we like follow-up questions. But right now, it’s the convention center, and move on.

Male reporter: General, a little bit more about why that’s happening this time, though, and did not have that last time…

Honore: You are stuck on stupid. I’m not going to answer that question. We are going to deal with Rita. This is public information that people are depending on the government to put out. This is the way we’ve got to do it. So please. I apologize to you, but let’s talk about the future. Rita is happening. And right now, we need to get good, clean information out to the people that they can use. And we can have a conversation on the side about the past, in a couple of months.

I think that the Long Term Care profession needs a spokesman like General Honore. Wouldn’t you love to hear the General say something similar to a regulator berating you about a problem you’ve already fixed?

“Hey Mr. Surveyor, don’t get stuck on stupid.”