NC Medicaid Work Group presentation

I had the opportunity to represent the NC Health Care Facilities Association before the Medicaid Reform Work Group today. My job was to advocate for the high quality, underpaid nursing homes of NC whose rates have been cut, whose rates have risen only 2 tenths of 1% since 2008, and are facing even more cuts. Who gets hurt? Our indigent parents and grandparents! See my remarks below. Thank you Mr. Chairman and Members of the Medicaid Reform Work Group. My name is Ted Goins. I’m President and CEO of Lutheran Services Carolinas based in Salisbury. I am here today representing the North Carolina Health Care Facilities Association. I’m joined by our President and CEO, Craig Souza. Since 1955, our organization has represented North Carolina’s skilled nursing home providers, both for profit and not for profit. Today there are 406 licensed skilled nursing facilities in North Carolina. States are mandated to provide skilled nursing care as a part of its Medicaid program. SNFs are a vital component of North Carolina’s comprehensive long term care system. It’s a system that focuses on person centered care, promotes choice, and offers a wide array of home and community based services. The North Carolina Health Care Facilities Association understands the need for Medicaid reform. Reform to me means “change for the better” and to achieve meaningful change for the better we must concentrate on program and systems reform, NOT just payment reform. Hundreds of thousands of North Carolinians are depending on us to get it right. We applaud the Department for recognizing that collaboration between all stakeholders will be required for reform efforts to succeed. Providers must play an active role in the debate. A debate that must be open, honest, and encourage new ideas and innovation. Much can be learned from the experiences of other states, but at the same time we should encourage and promote home grown solutions. To that end we want to thank Bob Atlas and Mardy Peal for their leadership in creating an environment that promotes openness and the full engagement of providers. No one would disagree with the three reform objectives established by the General Assembly: ​*Create a predictable and sustainable Medicaid program for taxpayers. *Provide care for the whole person by uniting physical and behavioral health. ​*Increase administrative ease and efficiency for NC Medicaid Providers. To have any chance of success DHHS and the General Assembly need to invest the necessary resources to enable Medicaid to function like the multi-billion dollar human services agency that it is. Reform needs to be done correctly, not quickly. Although budget predictability and certainty are the mainstays of reform, the program also needs stability, immediate stability. As we plan for reform, Medicaid “life” will go on. Best case, "reform" moves forward by maybe 2016 or 2017. In the meantime, we still have to do our jobs. We cannot compromise care while deciding what reform means. Hundreds of thousands of North Carolinians depend on Medicaid for vital health care services. Hundreds of thousands are also employed by hospitals, nursing homes, physician offices, and others. All providers want a predictable and sustainable Medicaid program. We need a system that is free of unnecessary regulatory burdens. We need state agencies that are responsive and data driven. We need reliable budgeting and accurate forecasting. We need sound reimbursement policies that reward quality and efficiency. And we need predictable and adequately funded reimbursement rates. And finally, we need a reliable claims processing system. Nursing homes ARE predictable. Utilization of skilled nursing services has steadily declined since 2009. Budget-wise, it’s pretty easy to project Medicaid payments to nursing homes. Daily rate times days of service. There you have it. I guess one could argue nursing home expenditures are already capitated. Medicaid rates for nursing homes are paid on a per diem basis. A facility receives a daily rate for all services provided. There are no additional fees. We are not fee-for-service providers. Nursing homes are also subjected to a federally sanctioned provider assessment program. The assessment draws down federal funding that reduces North Carolina’s matching rate (FMAP) for skilled nursing care. For every dollar spent on Medicaid services, the State pays roughly 35 cents and the federal government pays a matching rate of 65 cents per dollar. Because of the provider assessment, the effective state matching rate is about 20.8% or 21 cents per dollar. Since 2008, nursing home rates have increased by two tenths of one percent (0.2). Data shows costs for the same period have increased more than 10.5%. Ladies and gentlemen, I refer you back to the stated goals of reform. Objective #1: To create a predictable and sustainable Medicaid program for NC taxpayers. Not recognizing the impact of cost increases is not sustainable now and unless rectified, it will be a major barrier to meaningful reform. Interestingly, when private managed care is discussed as one of the possible options for reform, roughly 10 percent of the anticipated payments to MCOs is allowed for administrative costs and profits. I believe most Medicaid providers would gladly accept similar or even more reasonable terms. And the resources would remain in North Carolina. In spite of the challenging times confronting skilled nursing care, recent data from CMS and the OIG report that North Carolina nursing homes had the lowest hospitalization rates among the eight states in CMS Region IV, the southeastern U.S. We also had the largest percentage reduction in the use of anti-psychotic drugs in the nation. I mention these two issues because they were national benchmarks established by CMS and they can be areas we can build on as we make person-centered care a pivotal part of improvements to our Medicaid program. We have much to do. We have the talent within our State’s borders to build the nation’s best Medicaid system. We welcome the opportunity to engage in reform efforts. Mr. Chairman and members of the Medicaid Reform Advisory Group, I appreciate the opportunity to appear before you today. We are grateful for your leadership and we look forward to working with you. Thank you.

Improving care for people with dementia

Lutheran Services Carolinas opened its first official Alzheimer's neighborhood in 1991, and had an unofficial one around 1989. Many providers have closed or never opened space for people with dementia; they are generally low paying Medicaid recipients and it's not a profitable business model. In spite of those obstacles LSC has lived its mission: Empowered by Christ, we walk together with all we serve! LSC now has dementia or secure neighborhoods in 7 of its 8 free standing nursing and assisted living communities! Why? It's where the need is. Why? Christ said just as you have done it to the least of these you have done it to me. LSC has partnered with the Alzheimer's Association, Duke University, and others to learn how best to care for people with dementia. But LSC has always been constructively dissatisfied with its services, always looking for a better way. LSC was involved in the founding of Leadership Leading Age to raise up leadership in our organizations across the nation. LSC has sponsored two Leadership Leading Age Fellows. That program connected LSC to the Alzheimer's Resource Center of Connecticut. LSC received a state/federal grant to send 23 LSC team members to Connecticut to see first hand one of the nation's premier Alzheimer's care orgs. Many of our staff had never flown before. The visit was lifechanging for the attendees and for LSC. This week, the Connecticut people have spent the week training LSC teams from the participating LSC communities. All week I have been hearing reports and seeing pictures of phenomenal enthusiasm, change, and growth across our ministry. We've always done a good job of caring for people with dementia, but you ain't seen nothing yet. Tomorrow I get my chance. I get to go through the training with the Trinity Oaks team. Looking forward to learning personally how better to care for those who need us most. Stay tuned!

Disappointment

I am profoundly disappointed with our North Carolina state government. Our state is figuratively strangling some of the most vulnerable people in NC, specifically indigent nursing home residents! The state has not increased the rate that Medicaid pays for nursing home care in four years, that's 4 years!!! Our great nurses and nursing assistants rightly demand a wage increase every year. If they don't get more money, they can go somewhere else. The people that work at LSC aren't asking for the moon, but just enough to get by. And the price of food and electricity and gas keeps rising for LSC just like it does in our own homes. In the language of the farmers I grew up with, we are eating our seed corn. Lutheran Services Carolinas' seed corn is low turnover, quality care, and quality of life, all the things that make LSC communities a great place to live. How do we sustain what we have built for 50 years when we haven't had an increase in four years? And it gets worse. On January 1, 2014, every indigent nursing home resident in the state will be hit with a 3% Medicaid rate cut! Now, the law says that by January 1, 2015 the state is to decide on a plan to give us some of that money back in some type of "quality" incentive, but no one has decided on what that criteria might look like and if we get all, part, or none of that money back. It appears the cart is way ahead of the horse. It seems like we should have created a plan, then implemented the plan. We have implemented a plan, now we have to decide what the plan is. This rate cut is evidence of a larger problem. Nursing home expenditures are not the state's problem. Nursing home expenditures are stable. But Medicaid is rapidly expanding to cover more and more people. Somebody has to pay for that. Isn't it a shame that the poorest, oldest citizens in our state are bearing that burden? That is the disappointment!

Fab 50!!!!

On Monday, October 21, 2013 I joined about 100 people at the Hilton, Charlotte for a banquet in honor of the ten Fabulous 50 honorees from our District of our state health care association. Fab 50 winners are nominated by their peers and represent the very best direct care workers in North Carolina. Lutheran Services Carolinas had 3 of the ten honorees: Sherron Barnes from Trinity Oaks in Salisbury, Paulette Powell from Trinity Ridge in Hickory, and Noel Hathcock from Trinity Place in Albemarle! They were accompanied by their proud administrators (Bill Johnson, Tonya Hilliard, and Courtney Adams, respectively), their families, and some of their coworkers. COO Kesha Smith and I joined the party. It’s not often we get to visit, eat a great meal, and celebrate such important people. Sherron, Paulette, and Noel were gracious and spoke after receiving their individual awards, as did the other seven winners. One of the things that always impresses me most, and I have been to almost every Fab 50 event since it started, is that the honorees all say almost the same thing, but in their own unique and wonderful words about their vocation. It isn’t a job, it’s a vocation, a calling! Those words are what help keep me going till next year’s event, and are the words I want to share with you. Here’s what I got to hear: the glory belongs to God!, love to care, serve, we are all family, I treat others like I want to be treated, love the hugs and kisses, above and beyond, “my” residents, I do it out of love, without the residents we wouldn’t be here tonight, and on and on! Wow! I’m sorry that my words can’t do justice to the outpouring of love and devotion I see at each annual Fab 50 event. These ten are among the best caregivers in North Carolina. And there are hundreds more back home caring for people while we are at the banquet. So go visit your local health care community this week and thank those direct care workers! Call a CNA you know and thank them for their service; they make the world go round!

Below is the Lutheran Services Carolinas 2012-2013 Annual Community Stewardship Report, which highlights the great work and community benefit that happens through LSC.  Enjoy!

Community Stewardship Report – 2012/2013

In 2011, Lutheran Services for the Aging (LSA), established in 1960, affiliated with Lutheran Family Services in the Carolinas (LFS), a social ministry established in 1976 that has provided foster care, adoption, and veteran’s services as well as refugee resettlement, disaster response, residential care for people with disabilities and other services for vulnerable populations in both North and South Carolina. 

In June 2012, the Boards of LSA and LFS approved the name Lutheran Services Carolinas (LSC) for this new collective ministry.  The ministries of LSA are, generally speaking, represented by LSC senior services and the ministries of LFS are represented by LSC child and family services.

The new name is a reflection of the affiliation and represents the coming together of two long-established social ministries, who together have provided nearly 90 years of combined service to the people of the Carolinas.

The introduction of that new name also included new names for some LSC senior services programs, including the Lutheran Homes. LSC’s Lutheran Home - Hickory is now Trinity Village; Lutheran Home - Albemarle is now Trinity Place; and Lutheran Home at Trinity Oaks is simply Trinity Oaks.

Though the Lutheran Homes have proudly and compassionately served thousands of frail elders and others since 1962, sadly, the word Lutheran can make non-Lutherans feel excluded. The name Trinity was chosen as a strong and more inclusive name for these faith-based LSC ministries.

Also changing to the Trinity name were Abundant Living Adult Day Services, which has become Trinity Living Center; Elms at Tanglewood, which has become Trinity Elms; and Crescent View Retirement Community, which has become Trinity View.

LSC senior services opened its first ministry, a Hickory nursing home, in 1962 and has since expanded its services to include both frail and active seniors.  In 2012, 364,367 days of care and services were delivered to 2,474 older adults.  More than 1,400 employees delivered those services, and 2,363 volunteers supported residents, clients, and staff with 22,375 hours of volunteer work.

Recently, LSC has initiated the expansion of its home and community-based services by assuming the administration of the Rowan County Family Caregiver Support Program.  LSC is also a partner in PACE (Program of All-Inclusive Care for the Elderly), which opened January 2012 in Catawba County. In addition, LSC is collaborating in the development of PACE initiatives in Forsyth and Gaston Counties and in the development of SearStone, a not-for-profit continuing care retirement community in Cary. 

Today, LSC senior services is ranked as the 51st largest not-for-profit multi-site senior living organization in the United States and ranks 23rd in the provision of not-for-profit nursing home beds with an annual budget of nearly $100 million.  

In June 2010, LSC, then LSA, launched a $5 million capital campaign to add four new nursing homes, improve existing buildings, and expand home and community-based services.  The first of those homes, Trinity Grove, admitted its first resident June 6, 2011; the next nursing home, Trinity Glen, opened in June 2012, and Trinity Ridge will open in July 2013.

LSC seeks to serve and strengthen the communities in which they are located as indicated by the following:

SERVICES

• Nursing homes in Albemarle, Hickory (2), Salisbury, Wilmington, and Winston-Salem (2)
• Assisted living in Salisbury, Hickory, Arden, and Clemmons
• Independent living apartments at Trinity Oaks
• Independent living in a continuing care retirement center in Salisbury
• Independent living in a rental retirement community in Arden
• Specialized care for people with dementia in Hickory, Salisbury, Clemmons, and Wilmington
• Adult day services with specialized care for people with Alzheimer’s disease and other types of dementia in Salisbury
• Partnership in adult day services in Hickory
• Caregiver support in Rowan County
• Co-sponsorship of a HUD low-income elderly housing project in Hickory
• Rehabilitation services for post-acute and post-surgery patients at all nursing homes
• Respite care
• Hospice care
• Information and referral services for Lutheran congregations across the state
• Geriatric care management on a contract basis throughout the state
• Emergency shelter assistance for disaster relief or elders at risk

RESIDENT/CLIENT ACTIVITIES

• Project Linus – creating blankets and dolls for newborns of area hospitals
• Cultural diversity events
• Support of civic groups through memberships and fundraisers

• Habitat for Humanity volunteers
• Victory Junction toys and blankets for children with disabilities
• Salisbury Symphony volunteers
• Literacy Council volunteers
• North Carolina Transportation Museum volunteers
• Public library volunteers
• Provided stuffed animals to children in crisis
• Provided health and hygiene supplies for disaster relief
• Hospice volunteers
• United Way volunteers
• Humane Society volunteers
• Trinity View Singers perform at area health care facilities
• Trinity Oaks Ringers and Singers perform at area health care facilities
• Lap robes and crafts for nursing home and assisted living residents within and outside of LSA homes
• Tray favors for Meals-on-Wheels recipients
• Rowan Helping Ministries, Rowan Regional Medical Center, Meals on Wheels, and American Red Cross volunteers
• In-house volunteers
• Various programs for soldiers overseas
• Donations to food pantries, homeless shelters, libraries
• Samaritan’s Purse shoeboxes
• Gifts for Christmas to various organizations
• Safe Halloween trick-or-treat nights
• Community Easter egg hunts
• Ministerial appreciation events

EDUCATION

• Student internships for healthcare management or administration, business, recreation, psychology, sociology, and religion
• Intergenerational computer training and activities
• Provide service opportunities for student volunteers
• Preceptors for healthcare administrator AITs (administrators-in-training)
• Community college sites for classroom and clinical training for certified nursing assistant and CNA II programs
• Provide school supplies
• Mentors for college students
• Mentors for children at risk
• RN and LPN clinical training site for colleges and community colleges
• Clinical site for high school occupational training programs
• Vocational training site for exceptional children’s program
• Variety of school projects

HEALTH EDUCATION AND SCREENING

• Health educational programs open to the public on issues relating to personal health, Alzheimer’s, etc.
• Alzheimer’s support groups
• Grief support groups
• Participation in local health fairs
• Information and referral program
• Speaker’s Bureau
• Blood pressure checks

ADVOCACY

• Share information with all constituents on important issues such as adequate Medicaid funding, senior services, long term care
• Member Rowan L.I.F.E (Life Improvement For Everyone)
• Participation in civic organizations such as Civitans, Rotary, Kiwanis, Altrusa
• Diversity training/awareness for residents, staff, and communities
• African Descent Strategy Team of the NC Lutheran Synod
• Member of Board of Directors N.C. Health Care Facilities Association
• Member Board of Directors Wellspring Institute
• Member of LeadingAge
• N.C. Journal of Medicine Editorial Board
• Member American Health Care Association
• Board of Directors of Lutheran Services in America
• Member chambers of commerce across all service areas
• Member of other local and state committees and task forces

ENVIRONMENT

• Recycling programs
• Waste reduction programs
• Ecologically-sensitive decisions in construction and development projects
• Recycle computer/technology items
• Recycle medical equipment (wheelchairs, walkers, etc.)

SUPPORT SERVICES

• Food drives
• Clothing drives
• Host Senior Games
• Host community disaster preparedness events
• Provide volunteer opportunities for the community
• Provide concert site for school performers, bands, and choirs
• Provide concert site for symphony
• Host luncheons for area centenarians
• United Way Day of Caring
• Humane Society support
• Domestic violence shelter support
• American Cancer Society fundraisers
• Relay for Life fundraisers
• American Heart Association fundraisers
• Leukemia and lymphoma fundraisers
• Alzheimer’s Memory Walks
• American Red Cross Blood drives
• Alzheimer’s Support Group host and sponsor
• Provide community service opportunities
• Stanly Community College Service Learning Programs (vocational training)
• Provide badge opportunities for scouting
• Stanly County Youth in Transition Program (employment training)
• Group Homes for the Autistic (employment and skills training)
• Stanly Partnership for End of Life Care
• Nursing scholarships
• Suzuki School of the Arts performance site
• Bridges programs to encourage students and classes to visit residents
• Adopt-A-Grandparent programs
• School supply drive
• Campbell’s label collection for schools
• Bucket Brigade for disasters
• Christmas presents for needy children
• Voter registration program
• Provide meeting space for various groups, Rotary, Lions, Knights of Columbus, church groups, Girl Scouts, ombudsmen, community organizations
• Community service work program
• Thank you meals for area emergency service personnel
• Collect and recycle used eyeglasses
• Donate walkers, wheelchairs, etc. to Salvation Army, others
• Donate Physician’s Desk Reference books to nursing programs
• Donate medications to county community care clinics

COLLABORATIONS

• Partner with St. Andrew’s Lutheran Church and Bethany Lutheran Church in sponsorship of Lutherhaus, Inc., a 50-apartment HUD low-income, elderly housing complex in Hickory
• Partner with Adult Life Programs, Inc. in ownership of an adult day care building on the campus of Trinity Village (Lutheran Home – Hickory)
• Partner with Lutheridge, Inc. in a land lease for Trinity View (Crescent View Retirement Center) on the Lutheridge campus
• Agreements between LSC and Salisbury Academy, Catawba College, Livingstone College, Hood Theological Seminary, Caldwell County Community College, Catawba Valley Community College, Stanly Community College, Forsyth Community College, and Winston-Salem State University to promote institutional and personal collaboration and friendship.

On the child and family services side, LSC:

• Helped 60 veterans in North and South Carolina transition from homelessness back to dignity and self-sufficiency.

• Protected 419 children at risk of abuse and neglect in foster care.

• Improved the lives of 45 people battling severe and persistent mental illness by providing them with services to prevent unnecessary or repeated hospital admissions.

• Placed 19 children in loving adoptive homes.

• Provided sanctuary to more than 300 refugees and continued supportive services to over 500 other recent arrivals.

• Helped more than 300 families avoid homelessness through supportive services and life-skills training; provided homes, care, and support to nearly 100 people with developmental disabilities or similar life challenges; and provided counseling services to more than 80 men and women in crisis.

Christ said, “Love one another as I have loved you.” Love, care, compassion, and respect encompass the work of the LSC ministries.  All who work with LSC work with integrity and in a transparent manner.  

A gleam in your eye

The following story is making its way around the internet, and was shared with me by my brother.  It's not new and many would find it hokey.  However, it is true and it is exactly why Lutheran Services Carolinas is a strong, vibrant, important, growing ministry serving thousands of people!  All across and throughout our LSC family, most people have that gleam in their eye!  Have a nice gleam!  Ted

 How you choose to see things…

Three men were laboring in a field of boulders and large stones.  Sweat ran from their foreheads as they swung their heavy picks again and again.

A curious passer-by approached the men and asked each what he was doing.

The first man answered in a stern and abrupt voice:

Can’t you see, I’m breaking rocks!

The second man replied in a matter-of-fact way:

Can’t you see, I’m earning my salary!

The third man smiled--his eyes gleaming with enthusiasm--and proclaimed:

Can’t you see, I’m helping to build a cathedral!

The longer I live, the more I realize the impact of attitude on life.  Attitude, to me, is more important than facts.  It is more important than the past, than education, than money, than circumstances, than failure, than successes, than what other people think or say or do.  It is more important than appearance, giftedness or skill.  It will make or break a company, a church, a home.

The remarkable thing is that we have a choice every day regarding the attitude we will embrace for that day.  We cannot change our past…we cannot change the fact that people will act in a certain way.  We cannot change the inevitable.  The only thing we can do is play on the one string we have, and that is our attitude.  I am convinced that life is 10% what happens to me and 90% how I react to it.

 ~ Charles Swindoll

A Good Day

I worked an 8-hour shift on Friday as a nursing assistant at Trinity Grove, Lutheran Services for the Aging's nursing home in Wilmington, NC. I am proud that I started as a certified nursing assistant and try to pull a shift once or twice a year to help keep me humble and to keep in touch with the real world. Trinity Grove didn't disappoint. I worked with two other CNAs on the rehab unit: constant, fast pace, lot of change. When I work as a CNA, I don't hide my day job, but I don't broadcast it either. Toward the end of the day one of the residents figured me out and ask to see me before I left. This resident was toward the end of a lengthy stay in rehab and on the way home. When I went down to visit, the person pulled out a handwritten list. Was it going to be good or bad? The resident proceeded to share the following list: * love the neighborhood design of the building * room laid out well and wonderfully decorated * raised gardens and manicured lawn easy on the eyes * love the children's outdoor playground * live plants are great, fake are sad * staff are top of the line! * rehab nursing assistants & nurses are kind, loving, professional * therapists are professional and tops * food is delicious * recreation therapy is great, way beyond bingo * Administrator John Frye is always out and about, not in his office, even delivers resident mail sometimes to get to know everyone * Environmental services keeps building spotless I laughed and told the resident that I was waiting on the but--things that were wrong. There were none. There were a few very good ideas on how to make the building more resident friendly when we build the next building, which was very helpful. We will continue to learn and serve even better in the future. My mission was accomplished. I got to live in the real world of our ministry, and get a good dose of humble for the work of the men and women who execute our mission every day to express God's love in Christ that those we serve!