Ohio Governor Mike DeWine and Ohio Department of Aging (ODA) Director Ursel J. McElroy today announced the launch of the newly enhanced Ohio Long-Term Care Quality Navigator, which now includes information on assisted living communities in Ohio.
Formerly known as the Ohio Nursing Home Quality Navigator, the nationally recognized online tool provides users with detailed information about the quality of long-term care facilities across the state in one convenient digital location. The new name coincides with the addition of nearly 800 assisted living facilities to the Navigator, on top of the nearly 930 nursing homes that had previously been included.
To read the complete ODA release, please click here. Top You Asked:
When is a physician required to document in the medical record for residents who transfer or discharge?
We Answered:
In accordance with §483.15(c)(2), physician documentation is required in the following situations:
- The transfer or discharge is necessary for the resident’s welfare and the resident’s needs cannot be met in the facility;
- The transfer or discharge is appropriate because the resident’s health has improved sufficiently so the resident no longer needs the services provided by the facility;
- The safety of individuals in the facility is endangered due to the clinical or behavioral status of the resident;
- The health of individuals in the facility would otherwise be endangered;
Surveyor guidance states for circumstances where the discharge or transfer is necessary for the resident’s welfare and the facility cannot meet the resident’s needs or the resident’s health has improved sufficiently so that the resident no longer needs the care of the facility, the resident’s physician must document information about the basis for the transfer or discharge. Additionally, if the facility determines it cannot meet the resident’s needs, the documentation made by the resident’s physician must include:
- The specific resident needs the facility could not meet;
- The facility efforts to meet those needs; and
- The specific services the receiving facility will provide to meet the needs of the resident which cannot be met at the current facility.
In situations where the facility determines a resident’s clinical or behavioral status endangers the safety or health of individuals in the facility, documentation regarding the reason for the transfer or discharge must be provided by a physician, not necessarily the attending physician. Documentation of the transfer or discharge may be completed by a non-physician practitioner (NPP) in accordance with State law.
Additional guidance can be found in the State Operations Manual Appendix PP and in the revised QSO-25-07- NH memo. Top LeadingAge Ohio’s Advocacy Day on April 1 is the only grassroots event this budget season where aging service providers can come together to share their stories with Ohio’s lawmakers. Structured for both seasoned and new advocates, the day will include an issues brief in the morning, legislator visits, lunch with legislators and a panel of policymakers, statehouse tours, and opportunities to meet other leaders in the aging network. Attendees may also take advantage of training opportunities on issue messaging and the do’s and don’ts of meeting with legislators prior to Advocacy Day.
This is the opportunity for LeadingAge Ohio members to make an impact and have our voices heard. The bigger our crowd, the bigger impact our voices will have. That’s why LeadingAge Ohio has issued a challenge to our membership to fill the Statehouse Atrium with 100 provider attendees to ensure our presence is felt and funding is protected! Bring members of your team for an empowering day of advocacy on April 1. Click here to register today!
To learn more about the budget and LeadingAge Ohio’s budget priorities, listen to the recording of February’s Advocacy in Action call.
Watch LeadingAge Ohio’s most recent legislative testimony on budget appropriations at the 1-hour mark here. Join LeadingAge Ohio and the newly convening collaborative group, Ohio Palliative Care Access League (OPAL), for our first statewide Palliative Care Summit on May 15 at OCLC in Dublin. Registration is now available!
The summit is a kick-off of this group’s efforts to expand palliative care access across Ohio. This conference will bring together healthcare providers, health plans, policymakers, and community leaders to dive into topics surrounding palliative care including the need for and definition of palliative care in Ohio, the importance of early access, how to engage clinicians, clinical best practices, and care transitions across all settings.
The event will feature keynotes, moderated panels, and interactive discussions. You do not want to miss the opportunity to learn and network while helping to advance palliative care in Ohio!
Learn more here. On the Monday, February 17, 2025, Advocacy in Action monthly call, the group discussed the recently introduced FY26-27 State Operating Budget, its impact on the aging services sector, and budget priorities LAO will be pursuing as the bill winds its way through the House committee process. Items of interest in the budget were discussed, including the relatively flat funding levels seen throughout the measure, a phased transition from RUGS to PDPM, LNHA fee increases, and changes to Real Estate Investment Trust (REIT). Susan Wallace highlighted LAO’s budget priorities, which include seeking sustainability in Assisted Living & HCBS provider reimbursement; nursing facility payment reform; changes to hospice pass-through payments; and growing the Ohio Low-Income Housing Tax Credit (OLIHTC). Finally, the group was given an overview of the upcoming Advocacy Day at the Statehouse on April 1, 2025, as well as the LeadingAge Leadership Summit & Hill Day scheduled for April 7-9, 2025, in Washington DC.
The next Advocacy in Action call is scheduled for 10:00AM on Monday, March 17, 2025. Register for March’s Advocacy in Action here.
To watch a recording of Monday’s Advocacy in Action call, please click here. Join us on February 26 at 11:00AM for this live webinar that explores the integration and utilization of medication aides in senior living communities as a strategic solution to address staffing challenges, improve resident outcomes, and enhance operational efficiency. Attendees will gain insights into the role and responsibilities of medication aides, regulatory changes and considerations, and best practices for implementation. Join us to discover how this innovative staffing model can transform care delivery in your community.
Register for this February 26th live webinar here. Senior living is changing rapidly! Do you have what it takes to navigate the challenges ahead? At this year’s CFO Workshop, participants will join thought leaders to discuss the most challenging pressures: rising insurance costs, uncertain tax policy forecasts, and the growing encroachment of Medicare Advantage into healthcare, which narrows opportunities for margin.
Join your peers across the state for a day of in-person finance and strategy, to ensure you have the knowledge needed to position your organization for strength.
Learn more here. This week, LeadingAge Ohio proudly launched the Adult Day Services (ADS) Revitalization Project, kicking off a series of regional events aimed at strengthening and promoting ADS across the state. Our first event was a resounding success, bringing together ADS providers, referral sources, and aging services professionals to explore new resources, discuss challenges, and celebrate the essential role of ADS in supporting older Ohioans and their caregivers.
A special thank you to Western Reserve Area Agency on Aging for hosting our kickoff event and to all who attended! Your engagement and insights are critical to ensuring that Adult Day Services continue to thrive in Ohio.
If you missed the first session, there’s still time to participate! We have space available at 3 of our upcoming regional events, and we encourage you to register today. We invite all ADS providers, referral sources, caregivers, and aging services professionals to attend and be part of this important initiative.
For more information, visit www.AdultDayOhio.org.
Let’s work together to revitalize Adult Day Services in Ohio! Top Following much LeadingAge Advocacy in 2024, several federal agencies issued policy clarifications about how Medicare Advantage plan supplemental benefits, delivered through flexible benefit cards, should be treated when determining an individual’s eligibility for certain government assistance programs. LeadingAge has summarized this agency-by-agency guidance in a one-page flex card reference resource. The recording of Understanding the New Off-Cycle Nursing Facility Revalidations is now available on the LeadingAge Learning Hub. The webinar outlines key revisions to understand critical updates to the CMS-855A form, including changes to timelines and compliance requirements. Organizations will learn strategies for collecting data from board members, officers, directors, medical directors, and ADPs and take-home best practices for completing revalidation applications and mitigating non-compliance risks. The new compliance date is May 1, 2025, for all nursing homes to submit the revalidation off cycle application. LeadingAge will continue to monitor the updates to the 855A form guidance from CMS and alert members of any changes.
Learn more here. Top In an earlier alert and article, LeadingAge Ohio reported that Ohio’s biennial budget bill, HB96, was silent on whether Ohio should pursue a nursing-only or blended calculation for the new case mix index. Upon further review, the bill actually proscribes the state use only the nursing index:
“Incorporate the grouper methodology for the patient driven payment model nursing index used by the United States department of health and human services on October 1, 2019, for prospective payment of skilled nursing facilities under the medicare program;”
The article is corrected on the website.
LeadingAge Ohio is advocating for a blended case mix calculation that draws principally from nursing but also incorporates speech and language pathology as well as non-therapy ancillary components.
Questions related to this may be directed to Susan Wallace at swallace@leadingageohio.org. During the pandemic, nursing homes were one of the most severely affected sectors of the economy. Occupancy rates plummeted, caregiving moved into the home, and direct care workers became hard to find while operations costs increased, creating financial challenges across the sector.
In this new brief, the Scripps Gerontology Center at Miami University examines the financial performance of nursing homes during and after the pandemic and discusses what these results mean for the industry moving forward.
Read more here On February 19, 2025, Susan Wallace joined fellow aging services advocates in testifying before the Ohio House Children and Human Services Committee, reacting to the Ohio Department of Aging’s proposals included in the FY26-27 state operating budget, which were presented by Director McElroy the day before.
Wallace’s comments touched upon items included in the executive proposal that LeadingAge Ohio supports, including the increase to the Personal Needs Allowance (PNA) from $50 to $100. Susan also discussed items that should be considered moving forward, including support for a direct care workforce amendment that would mirror TechCred in reimbursing employers for microcredentials, collecting data to inform future increases in provider rates and reimbursements, and amendments to expand PACE and eliminate the eligibility waiting period by allowing for the immediate enrollment of participants to the PACE program during the determination process. Wallace also noted that the boosting senior services line item is a logical way to continue the success of the Healthy Aging grants.
Testimony recordings are housed on the Ohio Channel. Aging service associations testimony begins at 34 minutes, Wallace’s testimony is at 1 hour.
All testimony for the February 19, 2025 Ohio House Children and Human Services Hearing can be found here. Top A January 6 proposed Health and Human Services (HHS) rule designed to protect electronic protected health information would add significant new and detailed requirements compared to the existing Security Rule established under the Health Insurance Portability and Accountability Act. HHS states that the proposals would increase the cybersecurity for electronic protected health information by revising the rule to address changes in the environment in which health care is provided, significant increases in breaches and cyberattacks, as well as common deficiencies the HHS Office for Civil Rights has observed in investigations into Security Rule compliance by covered entities and their business associates. This LeadingAge article provides analysis. Top As previously highlighted in the LeadingAge Ohio’s The Source, the Centers for Medicare & Medicaid Services (CMS) has updated the Long-Term Care (LTC) Surveyor Guidance to enhance the quality and oversight of the LTC survey process. According to the revised QSO-25-07- NH memo, CMS added revised guidance and training for Nursing Services and Payroll Based Journal to the updates for Appendix PP and the Long-Term Care Survey Process and revised the effective date of implementation for all new guidance to March 24, 2025. In the surveyor guidance, CMS clarified guidance prohibiting admission agreements from containing language requesting or requiring a third-party guarantee of payment, adding examples of noncompliance.
In accordance with the transfer and discharge guidance at §483.15(c)(1)(ii):
When a resident chooses to appeal his or her discharge from the facility, the facility may not discharge the resident while the appeal is pending. If the resident, or if applicable, their representative, appeals his or her discharge while in a hospital, facilities must allow the resident to return pending their appeal, unless there is evidence that the facility cannot meet the resident’s needs, or the resident’s return would pose a danger to the health or safety of the resident or others in the facility. If there are concerns related to a facility’s determination that it cannot meet a resident’s needs, surveyors should assess whether the facility has admitted residents with similar needs. A facility’s determination to not permit a resident to return while an appeal of the resident’s discharge is pending must not be based on the resident’s condition when originally transferred to the hospital. Additionally, a facility may not transfer or discharge the resident while the appeal is pending, pursuant to § 431.230 of this chapter, when a resident exercises his or her right to appeal a transfer or discharge notice from the facility pursuant to § 431.220(a)(3) of this chapter, unless the failure to discharge or transfer would endanger the health or safety of the resident or other individuals in the facility. The facility must document the danger that failure to transfer or discharge would pose. CMS notes that for residents who have appealed their discharge and obtained a favorable ruling from the hearing, the resident or their representative may choose to report the discharge as a complaint to the State Survey Agency based on the favorable appeal ruling.
Learn more about transfer and discharge guidance in this on-demand webinar. The Center of Excellence for Behavioral Health in Nursing Facilities (COE-NF) will begin the Behavioral Health Action Network spring series in March. These three one-hour virtual sessions are free for nursing home staff and provide the opportunity to learn industry best practices from other nursing homes and behavioral health subject matter experts.
Learn more here. Top Not-for-profit LPCs received another round of good news on occupancy from three great sources: Ziegler Z-News, the National Investment Center, and a Wall Street Journal article on Boomers and the Seniors Housing Market. Overall, entry fee and not-for-profit LPCs showed the strongest occupancy in Q4 of 2024, at 91.3% and 90.7% respectively. Even in SNF occupancy, an area that across all types of LPCs (for and NFP, as well as entry fee versus rental,) has shown sluggish improvement if at all, LPCs generally outperformed non-LPC look-alikes. Coupled with the WSJ article, occupancy overall is predicted to only continue to improve, especially as increased demand from ‘aging Boomers’ leads to a potential ‘seniors housing shortage.’ For greater detail, please visit the hyperlinks in this briefing. Top United Church Homes (UCH) is proud to announce that it is now a Caregiver-Friendly Employer, reinforcing its commitment to supporting employees who balance their professional responsibilities with caregiving at home. As part of this initiative, UCH is offering its NaviGuide services free of charge to its employees, providing personalized guidance and resources to help navigate the complexities of caregiving. UCH recognizes the challenges that come with balancing work and family caregiving responsibilities and is dedicated to fostering a workplace culture that values and supports team members in every aspect of their lives.
Read more here. Top Developed by the National Center to Reframe Aging, this new LeadingAge Learning Hub resource, in a series of five short videos, offers strategies and tips to effectively convey nursing homes’ true impact, value, and essential role in supporting older adults. Impactful messaging about nursing home care–a unique, 24/7 service–is more important than ever, as America’s population is rapidly aging. Enhance communication and bolster perceptions of nursing homes using this practical tool that’s free to access. LeadingAge Ohio holds valuable education webinars and in-person events throughout the year. Opportunities are added weekly. See the complete Schedule of Events. Top
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