October 15, 2016

Keeping up: Challenges of faith-based retirement communities

I love serving as administrator at Spurgeon Manor in Dallas Center, Iowa. I love all our residents, our staff, and Spurgeon Manor’s mission, “Caring with respect and dignity in a loving Christian community.”

But, as with every job, there come changes and challenges— and that is certainly true in the area of health care. For administrators like me and in facilities like Spurgeon Manor, one area of increasing time and responsibility is the new reporting required by law.

In October 2014, Congress passed the Improving Medicare Post-Acute Care Transformation Act (IMPACT) and it was signed into law. This changed the role of administrators like me by adding several new reporting responsibilities. As an example, the Payroll Based Journal is now required, and nursing facilities must send to the Centers for Medicare and Medicaid (CMS) the hours worked by each individual direct care staff in a 24-hour period. This information is intended to be used, in part, to verify the staffing levels reported on each facility’s five-star rating, which can be found at the CMS web site called “Nursing Home Compare.”

The IMPACT Act also added other reporting requirements including preventable re-hospitalizations, rate of discharges back to the community, medication reviews, and average cost per beneficiary during and after skilled nursing discharge.

And that is not the end of the list. More changes to regulations and additional requirements of participation in Medicare and Medicaid include three additional focused surveys, new Life Safety Codes such as increased inspection and maintenance requirements, and new Emergency Preparedness requirements for tested plans for different types of emergencies to meet residents’ needs, among others.

When a law like the IMPACT Act is passed, it can take time before all the requirements are identified and implemented. That is where our active participation in our state health care association is important, for the education and support that organization provides.

This all takes time, with many hours invested in reading and understanding regulations and the new contracts involved. The most recent contract was nearly 90 pages, and it was one of the many I reviewed and signed so far this year.

In addition to this type of work, retirement communities have been facing more and more financial challenges. Collecting state payment from Managed Care Organizations (MCOs) for residents whose support mostly comes from the state, and also from Medicare Advantage Plans, requires an inordinate amount of time and additional work to track payments and ensure collections. And there is the front-end work of obtaining pre-authorizations and reauthorizations. In Iowa, since the state has contracted with the MCOs, payments have been delayed. Iowa is not nearly as bad off as states such as Illinois, where the state budgets have become political footballs and retirement communities simply may not be paid the money that the state owes them for the care of such patients.

So I want you to know that I have been in my office or at meetings more than ever before in my career, for good reason. Spurgeon Manor has a great team of caring individuals committed to the highest quality of care. I feel we are ahead of most of our competition and are committed to do whatever it takes to remain in front. And yes, I am competitive, I love my job, and I want Spurgeon Manor to be the best it can be!

Maureen Cahill is administrator of Spurgeon Manor, a Church of the Brethren-related retirement community in Dallas Center, Iowa.