Immanuel Lutheran participates in national study of how nursing homes allocate resources

The Daily Inter Lake

The staff at Immanuel Lutheran home spent part of last week using little blue boxes to track and time themselves on the job for the good of nursing homes across the nation.

It's part of an effort to update the Medicare/Medicaid payment systems to facilities such as Immanuel Lutheran Home.

What did the 54 residents involved think of all this monitoring?

"I haven't heard anything from the residents," said Linda Canfield, director of nursing.

And the staff under the microscope? Canfield said they just "took it in stride."

That's the seamless way she hoped the study would flow when in January the Iowa Foundation for Medical Care asked the home to participate. The Centers for Medicare and Medicaid Services hired the group to study how nursing homes allocate staff time and resources.

Immanuel Lutheran Home, along with Brendan House, was selected to participate in this national study. Seven other long-term care facilities in Montana also participated.

"I was told it was based on quality indicators - they chose the better performing facilities," Canfield said.

Steve Blazina of the Senior Long Term Care Division of the Department of Public Health and Human Services arrived Monday with two staff members trained to oversee the data gathering.

Canfield and Blazina said that today's Medicare/Medicaid payment systems were based on an obsolete picture of the services performed in skilled nursing homes.

"There hasn't been an update since 1997," Blazina said.

As a result, Immanuel Lutheran Home's reimbursements for care fall short of the cost to provide it. Many other nursing homes have the same dilemma, and some smaller facilities have closed.

Canfield said that resident populations have shifted drastically in the past 10 years because of the proliferation of assisted-living facilities and changes in the way Medicare reimburses hospitals.

"People do everything they can to stay independent until they need our level of care," Canfield said. "That's the new trend in the industry."

The average ages of today's nursing-home residents are 85-90, and they require more intense care than younger seniors.

Immanuel Lutheran and other skilled nursing facilities also serve a larger convalescent function since changes in Medicare's payment system mandated shorter hospital stays for many conditions afflicting the elderly.

She said patients used to be in a hospital for 8-10 days but now are moved to skilled nursing homes after two or three days. As a result, homes provide more medical care than in past years in addition to rehabilitation.

"We get more subacute patients," Canfield said.

Blazina said staffs provide more "hands-on care" to the older and sicker nursing-home populations of today.

This effort, part of the STRIVE program - Staff Time and Resource Intensity Verification study - set out to document these many changes.

On Monday, Blazina and other state staff provided basic training to Immanuel Lutheran employees in research categories and in recording data with the little blue boxes called Personal Data Assistants.

"It's like a little computer," Blazer said.

He demonstrated the device, using a stylus to punch boxes on the screen to sign in a staff member then check a resident served and other information before starting the clock ticking to measure a task.

Blazer, who worked with day staff, up loaded the information into a laptop at the end of each shift.

"We can make corrections for any gaps where someone forgot to start or stop," he said.

Immanuel Lutheran Home employees involved were registered nurses, license practical nurses, certified nurses aides, dietitians, therapists, recreation staff, social service professionals and a care plan coordinator .

At first, some employees who were not computer-savvy worried about interfacing with the little blue devices. But younger staff members paired up with some of the older ones who had problems.

No one was forced to use the PDAs.

"They knew they could do it [data recording] on paper if they wanted," Canfield said. "I only had two who preferred paper."

Apparently, the paperless information age made some converts. Canfield said with a laugh that now she has staff inquiring about going to electronic charting.

She said some of employees with 15-20 years on the job go about their days without really considering how many tasks they performed in a given shift. The review of their data at the end of a day was eye-opening.

"They said 'Wow, I did that all in one day,'" Canfield said.

Canfield and Blazer expect the same sort of reaction from federal reviewers when they look at the research report. It's due for completion in the spring or summer.

"I think they will have a good view of what it takes to give good care," Canfield said.

Because the state Legislature only meets every two years, changes in Medicaid may be delayed until at least 2009. Canfield said the federally administered Medicare changes could occur sooner.

Without changes, Blazer and Canfield foresee a crisis developing with the numbers of aging people set to grow, particularly in Montana.

"Reimbursement rates haven't kept up to speed with the economy, wages, the nursing shortage - everything," Canfield said.

kkellogg 10/19/06 Nursing homes face the same employee shortage with which other Flathead businesses struggle. To compete for nurses and other employees, they need better reimbursement rates to provide incentives to attract and keep these highly trained professionals.

"Nursing is not the glamorous job people think it is," Canfield said. "It's hard work, emotionally taxing and back-breaking-especially in long-term care."

Along with participating in the study, Immanuel Lutheran Home is also tackling the challenge with a plan to switch to a resident-directed care concept.

It allows more flexible staffing while allowing residents flexibility in when they get up and eat meals.

"It's more like what they did in their things in the home setting," she said.

Canfield said the baby boomer generation has inspired and pushed forward this change in the industry.

"As far as the consumer goes, it's going to enhance the quality of care," she said.

Reporter Candace Chase may be reached at 758-4436 or by e-mail at cchase@dailyinterlake.com.