Friday, September 1, 2017

Tilting At Windmills, Parts 1 and 2

I try to keep my head down and do my work, but every once in a while I just can’t help but tilt at a windmill. I’ve tilted twice recently, and with the same results as Don Quixote.

My first windmill is an issue that frustrates long term care providers across the country, specifically for me here in North Carolina. The federal government has created a punitive and in many cases perfection-requiring regulatory environment. Violations can easily result in fines and other penalties. The fines were my latest windmill.

The federal government (Center for Medicare and Medicaid Services or CMS) determined that these fines will accumulate and then can only be used to improve the quality in nursing homes across in our case the state of NC. The fines can only be accessed by applying for grants from the fund of fines. It was particularly frustrating to hear that the fines have accumulated to a total of $23 million! That money sitting in the bank is not improving quality for anyone.

In NC, state employees and the NC Culture Change Coalition review and preliminarily approve all grants, which are then approved or disapproved by the federal government. The state employees and the Coalition have been extremely helpful and collaborative. But the federal restrictions are onerous.

I wrote the head of CMS in hopes that the new federal administration’s desire to relieve regulatory burdens might provide some relief. Utilizing fines to improve quality is a worthy goal; it’s just that the bureaucracy gets in the way. The Death of Common Sense is the book that helped shape me years ago. Read it if you have time.

Now, I realize my plan was way out there, and way too simple. Since there is $23 million sitting there, nearly inaccessible, why not call a re-set. My suggestion was to leave $3 million in the fund to fund the few grant requests that can pass muster. I suggested the other $20 million be used to give a $500 bonus to every full time certified nursing assistant (CNA) who works in nursing homes in North Carolina. Even today, I cannot think of anything that would be more beneficial to the quality of care of all of our state’s residents than the promise of two years of bonuses. But apparently and sadly, the federal rules do not allow the fine money to be used for the things like wages or bonuses that would have the greatest impact on quality.

There were two reasons for tilting at this particular windmill: to honor every North Carolina CNA for their hard, hard work and because I thought we could take the lead on this issue. You see, LSC’s nursing home leaders have been very innovative, and we were willing to brave the regulatory requirements. We’ve gotten our fair share of the grant money, or more, so we didn’t have to whine because we weren’t getting grants.

Anyway, I had my say and got the reply I was expecting. My only hope is that this attention and the current administration’s desire to rein in over-regulation might conspire to get that money used to improve the quality in our state’s nursing facilities.
Round two is not quite so bad, and I didn’t start it, thank you very much!

The last week in August 2017 the Governor of South Carolina sent a letter to the Department of Homeland Security requesting that no refugees from the 6 Muslim countries in the Afghanistan area be relocated to SC. We immediately started getting press requests.

I shared that LSC has resettled thousands of South Carolinians from around the world, and will continue to do so in accordance with all applicable laws. The United States already performs extreme vetting on every refugee entering the country, which we feel is important to keep us all safe. After resettling over 12,000 refugees in the Carolinas without incident, LSC encourages all people to fulfill our biblical mandates to love one another and to welcome the stranger.

Further, we are in midst of the largest humanitarian crisis in world history. The US has always been a world leader and we need to be leading now.

At a time when our government has drastically cut the number of refugees coming to freedom, I have been advocating the US should be admitting 200,000 refugees each year. If we are going the be the leaders of the free world, we need to start leading!

The tilting is really trying to make sense out of the discussion. Refugees are already extreme vetted! No refugee has killed anyone in the United States since the Refugee Act of 1980 was enacted! Refugees are not a threat. I want our governments spending their time and energy on a government’s mission of public welfare and public safety. That means jobs, mental health, crime, drugs, and national defense. Now that’s tilting!

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