Collaborating for Quality

Wisconsin Coalition for Collaborative Excellence in Assisted Living Rewards Quality

A publication for Wisconsins Long-Term Care Profession by
Fall 2014
Including:
Provider Community Calls for Greater State Investment
National Media Sings Praises of Music and Memory
Alzheimers Association, Southeastern Wisconsin Chapter Head Works with Providers
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Welcome
WHCA/WiCAL Prepares for Constant Change
Within the long-term care provider community it has become
all too clear that constant change is here to stay. The Wisconsin
Health Care Association and the Wisconsin Center for
Assisted Living (WHCA/WiCAL) are not immune from this
truism. Indeed, the two divisions and their respective facilities
must constantly be ready to anticipate, assess and adapt to the
ever-changing challenges for Wisconsins skilled nursing and
assisted living member facilities.
Wisconsins and the nations long-term care delivery
and payment systems have undergone monumental
transformation in the last decade. But the changes we have
thus far witnessed will pale in comparison to the magnitude
of the overhaul on the horizon. The new challenges and
opportunities we will confront call for both new forms of
analysis and dramatic innovations in the way we conduct
existing operations. Workforce shortages, measurement
of outcomes and quality, integration and delivery of care,
and the stability of funding will be integral elements to the
challenges we face. Our issues and their complexity will
exacerbate markedly as the tidal wave of baby boomers
increasingly require and demand quality long-term care
services.
Successful preparation for todays and tomorrows challenges
dictates that WHCA/WiCAL possess an enhanced capacity
to analyze the scal, nancial, clinical and other LTC data
that will drive public policy and private decision-making.
To that end, WHCA/WiCAL is proud
to announce that Kate Van Camp has
joined WHCA/WiCAL in the newly
created role of Director of Research
and Data Analysis. A Masters of Public
Affairs graduate of the Andrew Young
School of Policy Studies at Georgia State
University with a graduate certicate in Public Health,
Kate has an impressive background in quantitative analysis
and statistical research. She has held key internships with
the American Cancer Society, Childspring International
and the Lupus Foundation of America. Kate will bring a
new and dynamic dimension to WHCA/WiCALs ability
to assess and articulate public policy that will produce the
most productive impact for those who receive and provide
care in Wisconsins long-term care facilities. Her education,
experience, and interests make Kate a perfect t for this new
staff position. Kate can be reached at kate@whcawical.org.
Paralleling Kates arrival at WHCA/WiCAL will be a
transformation and reinvigoration of the Associations
committee structure. The structure, role, and composition
of key committees is being rened and refocused to better
assure that all association staff are afforded direct and
consistent access to the pulse of its membership. Through
that improved access to expertise within the membership,
WHCA/WiCAL will be able to more effectively identify
and respond to the individual and collective concerns of
the membership and the LTC community.
The staff and structural changes at WHCA/WiCAL will
provide its membership with tools for better understanding
and improving long-term care and quality. It will enable
WHCA/WiCAL to explore and advance new models for both
the delivery and payment of care; to assess and compare best
practices in emerging new arenas; and provide leaders and
policymakers with enhanced quantitative information to make
informed decisions. In addition to providing new evidence,
it will allow us to better understand and articulate existing
knowledge to be more relevant to the issues we face.
Sincerely,
Tom Moore
Executive Director
WHCA
Brian Purtell
Executive Director
WiCAL
OCTOBER 22-24, 2014
Wisconsin Dells, WI

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Contents
Fall 2014
6
CAPITOL CONNECTION
Provider Community Calls for Greater State Investment
LTC Involvement in November Elections Critical to Make Our Voice Heard
With the upcoming Fall Election, Capitol Connection offers a preview of the key legislative
races on the ballot on Nov. 4, 2014. With races deciding control of the Governors ofce,
Wisconsin State Senate and State Assembly, the election this Fall will have a substantial
effect on the future of the long-term care profession in the coming years.
MEDIA MATTERS
National Media Sings Praises of Music and Memory
Wisconsin Initiative Grabs Positive Headlines from Across the Country
Since its launch last year, the Wisconsin Music and Memory Initiative has garnered
signicant national media attention. Currently, the Wisconsin Department of Health
Services is in the process of expanding the program. The Music and Memory Initiative is
a program thats a win-win for everyone by improving quality, enhancing outcomes and
providing a positive news story about long-term care when the news media rarely pays
attention to the positive stories within our profession.
CLINICAL CORNER
Establishing a Prescription Drug Formulary
New Law Allows Wisconsins Skilled Nursing Facilities to Set up Formularies
Thanks to a bill signed into law by Gov. Scott Walker this Spring, skilled nursing facilities
in Wisconsin are now able to develop prescription drug formularies. The two experts who
participated in WHCA/WiCALs webinar on setting up a prescription drug formulary
offer their advice on going through the process of a skilled nursing facility setting up a
prescription drug formulary for the residents.
COVER STORY
Collaborating for Quality
Wisconsin Coalition for Collaborative Excellence in Assisted Living Rewards Quality
The Wisconsin Coalition for Collaborative Excellence in Assisted Living is a comprehensive
quality assurance, quality improvement program based on the premise that when assisted
living communities implement internal quality assurance and quality improvement
throughout their systems, they will have better outcomes. The program, which was
developed in partnership with long-term care provider associations and the Wisconsin
Department of Health Services, offers tangible and intangible rewards to providers who
participate and demonstrate quality outcomes.
STAKEHOLDER SPOTLIGHT
Alzheimers Association, Southeastern Wisconsin Chapter Head Works with Providers
Executive Director Tom Hlavacek Works with Provider Groups to Ensure Positive Outcomes
Tom Hlavacek, Executive Director of the Alzheimers Association, Southeastern
Wisconsin Chapter, offers the perspective of his organization regarding the challenges and
opportunities facing the community ghting Alzheimers and dementia.
LTC LEGAL LETTER
Top-5 Reasons Providers Need to Review Advance Directives
Policies, Procedures and Forms Critical for Wisconsins LTC Providers
Skilled nursing facilities have heightened expectations found in the revised F155 and
recent CMS interpretations, while all providers have some regulatory expectations to
communicate about and know the status of residents advance care planning wishes.
Practical considerations also include clearly communicating what a facility is willing and
able to provide with regards to meeting residents wishes. Make sure that your facility is
prepared to meet its regulatory and practical obligations regarding advance care planning.
14
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Continuum is published for the
Wisconsin Health Care Association
and the Wisconsin Center for
Assisted Living
131 W. Wilson Street, Suite #1001
Madison, WI 53703
Phone: 608.257.0125
Fax: 608.257.0025
www.whcawical.org
Managing Editor
John J. Vander Meer
Publisher
Dean Gille
Editor
Melissa Keller
Account Manager
Abbie McDowell
Creative Director
Sara Rice
Layout & Design
David Cox
Published by
1155 Wilburn Road
Sun Prairie, WI 53590
608.834.3400
www.bgsinc.com
For more information in advertising in
Continuum call 608.257.0125 or go to
www.whcawical.org/continuum.
If you are planning on moving and
would wish to continue receiving
Continuum, call 608.257.0125 and
inform WHCA/WiCAL of your new
address.
2014 Badger Graphic Systems.
All rights reserved. The contents of this
publication may not be reproduced by
any means, in whole or in part, without
prior written consent of the publisher.
PUBLISHED OCTOBER 2014
FALL 2014 | CONTINUUM 5
The September poll
results clearly indicate
the race for Governor of
Wisconsin is very close
at this time.
Provider Community Calls
for Greater State Investment
LTC Involvement in November Elections
Critical to Make Our Voice Heard
By Jim McGinn
Capitol Connection
O
n Nov. 4, Wisconsin voters will
select individuals who will represent
them in Washington D.C., Madison,
and county ofcers. Also included on the
ballot are referendum questions in several
counties which are intended to advise
the State Legislature to adopt policy/laws
reecting the support of the voters and
perhaps generate additional interest in
voting by certain constituencies.
Wisconsins constitutional ofces
of Governor, Lieutenant Governor,
Secretary of State and Treasurer, and
the Attorney General will be decided by
the voters on Nov. 4. Also, candidates
for all 8 Congressional seats, all 99
Assembly seats, and 17 of the State
Senates 33 seats are up for election.
Prior to an overview of the November
election, it may be appropriate to
briey review why elections are
important and have consequences.
Early next year, the Governor is
required to present his/her budget
recommendations to the Legislature
for its review and nal approval. The
budget bill is the most important bill
to be considered and the only measure
that must be passed by the Legislature.
2015-17 STATE BUDGET BILL
Currently, Wisconsins $73 billion
biennial budget bill provides the
funding to state agencies and the UW-
System to implement the policies
and programs of state government.
State dollars are appropriated to fund
the Medicaid program as well, which
reimburses providers for services
to residents with limited income.
These providers include skilled
nursing facilities, hospitals, doctors,
dentists, assisted living facilities, and
local governments. Managed Care
Organizations also receive Medicaid
dollars through Family Care and
contract with assisted living facilities
to provide long-term care services for
eligible individuals.
The Governor and Legislature
determine the level of funding for
programs in the state budget bill, and
if the provider community is calling
for greater state investment in long-
term care programs, the provider
community must communicate these
needs to candidates.
The UW-Systems Board of Regents
has already communicated their 2015-
17 biennial budget requests to the
Department of Administration, voting
to request a $95.2 million increase
in state funds for higher education.
The Regents recommendation is
supported by detailed explanations
as to where the dollars will be used
and how those dollars will support
economic growth in Wisconsin.
The UW-System intends to utilize
increased state funding to build
a Talented-Based Economy by
increasing graduates in the sciences,
technology, engineering, and math
and to reduce the length of time it
takes to earn a college degree. The
proposed higher education budget for
the UW-System identies priorities
and includes a plan to invest state
taxpayer dollars to attain a growing
economy in Wisconsin.
Long-term care providers should
follow the example of the UW-
System and communicate their needs
to candidates for state ofce. Tours
of facilities and discussions with
Legislators and candidates for
ofce should be held annually, but
especially between Labor Day and
Election Day this year.
Most Legislators and candidates are
familiar with the nursing facility
bed tax, but may not know that 24
years ago the nursing facility bed tax
was approved by the Legislature and
Governor to generate matching federal
funds that would be used exclusively
to support and improve resident care.
Today, the average skilled nursing
facility (100 beds) pays $204,000 in
nursing facility bed taxes per year.

First enacted in Wisconsin in 1991
at $32 per month, the bed tax was
increased to $75 per month in Gov.
Jim Doyles 2003-05 state budget and
increased to $150, and then $170 per
month in Gov. Doyles 2009-11 state
budget. Unfortunately, as the bed tax
increased and additional federal funds
were generated, Gov. Doyle used the
vast majority of the federal dollars to
fund other Medicaid base expenditures,
often referred to as the skim.

Gov. Scott Walker has never proposed
an increase in the nursing facility bed
tax and has actually reduced the skim
from approximately $45 million to
Continued on Pg. 8
6 CONTINUUM | www.whcawical.org
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FALL 2014 | CONTINUUM 7
With respect to the State Senate
and the 17 seats up for election,
Republicans control the upper
house, 17-15 with 1 vacancy
which is a Republican-leaning seat.
It is not too difcult to predict
that Democratic Senators Tim
Carpenter (D-Milwaukee) and John
Eprenbach (D-Madison) will be
elected as they are unopposed and
Republican Senator Leah Vukmir
(R-Wauwatosa) will prevail as
she is challenged by a Libertarian
candidate.
Republican candidate and former
Sen. Van Wanggaard (R-Racine) is
expected to win the 21st Senate District
seat, which would give the Republicans
an 18-14 advantage with 1 vacancy.
The key Senate races to watch are:
District 9 (Sheboygan-Manitowoc),
where Democrat Martha
Laning faces Republican Devin
LeMahieu; District 17 (parts
of Green, Lafayette, Green,
Richland, Monroe, and
Sauk counties) where
Democrat Pat
Bomhack faces
Republ i can
H o w a r d
Marklein;
a n d
Di s t ri ct
approximately $14 million. As in
previous state budget bills, WHCA
is requesting complete restoration
of the remaining $14 million bed
tax revenue skim in the 2015-17
budget bill. The budget bill should
restore the integrity of the bed tax and
apply all funds generated by skilled
nursing facility tax payments to meet
the needs of individuals receiving and
providing care in Wisconsins skilled
nursing facilities.
The proposed 2015-17 budget bill
will include funding to expand the
Family Care program statewide and
perhaps an initiative to improve and
expand services for individuals with
Alzheimers and related dementias.
But to build and increase a network of
services, the budget bill must include
investing the necessary resources
(dollars) to adequately reimburse
providers for serving enrollees of
Family Care and expanding the
care available for residents with
irreversible dementia.
NOVEMBER 4
The Wisconsin Blue Book notes
that based on information from the
Department of Administration, it is
estimated that in January 2012 there
were about 4.4 million potential voters
18 years of age and older. According
to the Government Accountability
Board, an estimated 70% of eligible
voters cast about 3.1 million ballots in
the 2012 presidential election.
The most watched and most
important race statewide in 2014 is
the Governors race, with incumbent
Republican Gov. Scott Walker being
challenged by former Trek Bicycle
executive and Secretary of Commerce
Mary Burke.
On Sept. 17, the latest Marquette
Law School poll found that 46% of
registered voters support Gov.Walker
and 46% support Democratic
challenger Mary Burke with 5%
undecided. The poll noted that
among likely voters, dened as those
who say they are certain to vote in
Novembers election, Gov. Walker
received 49% and Candidate Burke
received 46% with 4% undecided.
The results for both registered and
likely voters are within the polls
margin of error.
The September poll results are similar
to the three recent Marquette Law
School Polls and clearly indicate the
race for Governor of Wisconsin is
very close at this time.
Charles Franklin, professor of law
and public policy and director
of the Marquette Law School
Poll, will provide an update
on all key races this November
at the WHCA/WiCAL Fall
Convention on Oct.
23. Prior to that
presentation, it
may be helpful
to review
some of
the key
legislative
races.
Capitol Connection Continued
8 CONTINUUM | www.whcawical.org
Providing quality rehab services to patients
and long-term care facilities since 1977.
Our mission is to provide rehabilitation
and related services in an atmosphere
of integrity, trust and compassion,
glorifying God in all that we do.
Jane Beisser, OTR, Vice President
2448 S. 102nd Street Milwaukee, WI 53227
414.329.2429 Jane.Beisser@mjcare.com
www.mjcare.com
Jane Beisser, OTR, Vice President
2448 S. 102nd Street Milwaukee, WI 53227
414.329.2429 Jane.Beisser@mjcare.com
www.mjcare.com
James McGinn
is WHCA/
WiCALs Director
of Government
Relations. He can
be reached at
jim@whcawical.org
Again, if anyone feels it is not
important to vote, the four
Assembly races noted above were
decided by less than 1% of total
votes cast, no landslides, and every
vote was counted more than once
by local voting ofcials.
Recognition of the importance of
long-term care issues only occurs
when local skilled nursing and assisted
living facilities support and work with
area legislators/candidates as this
election season moves forward.
19 (Appleton, Neenah, Menasha)
where Democrat Penny Bernard
Schaber faces Republican Roger Roth.
While all 99 seats in the State Assembly
are up for election, The Wheeler Report
notes 28 Assembly Republicans and
19 Assembly Democrats will be voted
into ofce on Nov. 4 since they are
unopposed. Republicans control the
State Assembly 60-39 and while that
number will change, Republicans are
expected to continue to control the
Assembly in the 2015-16 session.
The key Assembly races to watch are
located in the Fox River Valley from
Fond du Lac to Green Bay and the
Chippewa Valley, the Eau Claire-
Chippewa Falls area. These two areas
of the state historically have very
competitive races and often times
determine which party will control
the Legislature.
Other Assembly races of interest
include: District 70 (Milladore-
Sparta-Tomah) where incumbent
Democrat Amy Sue Vruwink again
faces Republican Nancy Vander
Meer, who she beat by 144 votes
(27,000 votes cast) in 2012; District
72 (Wisconsin Rapids-Plaineld)
where incumbent Republican Scott
Krug faces Democrat Dana Duncan
in a district won by Rep. Krug in
2012 by 109 votes (28,000 cast);
District 75 (Washburn-Burnett-
Douglas counties) where incumbent
Democrat Stephen Smith faces
Republican Romaine Quinn in
a district won by Rep. Smith by
615 votes (28,000 cast) in 2012;
and District 93 (Pierce-Pepin-
Dunn-Eau Claire counties) where
incumbent Republican Warren
Petryk again faces Democrat Jeff
Smith, who he beat by 498 votes
(31,000 cast) in 2012.
FALL 2014 | CONTINUUM 9
Media Chorus Sings Praises
of Music & Memory
Wisconsin Initiative Grabs Positive
Headlines from Across the Country
By John J. Vander Meer
T
heres an expression in journalism
bad news is good news For
one reason or another, sometimes it
seems like the news media only pays
attention to long-term care providers
when theres bad news to report.
However, an initiative spearheaded
by the Wisconsin Department of
Health Services this year has had news
outlets here in Wisconsin and around
the country singing a different tune.
The Wisconsin Music and Memory
Program is part of a national program
developed to train skilled nursing
facility staff to create personalized music
playlists for residents diagnosed with
Alzheimers disease or related dementias.
Since its launch last year, the
Music and Memory Program has
garnered signicant national media
attention. From ABC World News
to a recent story in the Milwaukee
Journal Sentinel to many accounts
in community newspapers and
television stations across the State of
Wisconsin, the Music and Memory
Program offers the news media a
unique opportunity to tell a heart-
warming story about technology
improving peoples lives, providers
offering quality care, and all without
the need for reactive and punitive
enforcement measures.
Currently, DHS is in the process of
expanding the successful program.
In the rst round of funding, the
Department made funds available
to 100 skilled nursing facilities, and
in the second round of funding
another 150 facilities will receive
grant resources to establish their
own programs.
Earlier this year, the documentary
lm Alive Inside, directed by
Michael Rossato-Bennett, debuted
at the Sundance Film Festival to rave
reviews. Screenings in Milwaukee
and Madison are also scheduled
for this fall. The lm
d e mo n s t r a t e d
the dramatic
impact the
tool of music
t h e r a p y ,
c o u p l e d
with the
development
of personalized
playlists from
a persons life,
can have on
the quality of life for people with
dementia.
The story of Alive Inside, shows how
people suffering from Alzheimers or
dementia can be lost to the world
around them; until, headphones
playing the music cause them to
light up. Whether listening to big
band swing or the Byrds, gospel or
Frank Sinatra, for people suffering
with Alzheimers disease or related
dementias, music provides a window
into a world some may think that they
had lost permanently.
According to Music and Memory
founder Dan Cohen, MSW,
neuroscience research, which guided
the creation of the program, has
Media Matters
The Music and Memory
Initiative is a win-win
for everyone
10 CONTINUUM | www.whcawical.org
shown the program to enhance the
lives of residents with Alzheimers
disease or other dementias by:
Reducing the use of medications
Reducing agitation and sun-
downing
Enhancing engagement and
socialization, in turn fostering
a calmer social environment
Increasing pleasure to persons
with dementia
Increasing cooperation and
attention of patients
Boosting staff morale by
reducing the resistance to care
Increasing fullling engagements
among the residents, staff,
family, friends, and their
community.
The Music and Memory Program is
a win-win for everyone: advancing
quality of care, improving outcomes
for residents, and offering a positive
news story about long-term care.
WHCA/WiCAL, in partnership with
other provider community groups
and the Department has also reached
out to members of the long-term
care provider community to seek
donations to expand the scope of the
Initiative beyond program and grant
revenue. WHCA/WiCAL Associate
Members are welcomed to participate
in this effort as well. In fact, earlier
this summer, WHCA/WiCAL was
pleased to receive the donation of
an iPod Touch from Stephanie
Langen, account representative of CE
Solutions, for use in the Music and
Memory Program.
If you have a Music and Memory
program in your facility, reach out
John J. Vander
Meer is WHCA/
WiCALs Director of
Communications.
He can be reached at
john@whcawical.org.
to your local newspaper or television
station and tell your facilitys good
news. If you are uncomfortable
with inviting members of the news
media into your facility, why not
write a letter to the editor of your
local newspaper so you can discuss
the benets of participating in the
Initiative generally.
The press will always consider bad
news to be good news, but that just
increases the importance of making
sure the media tell the positive stories
when they come along.
For more information:
http://www.dhs.wisconsin.gov/
music-memory
Senior Living
Insurance Specialist
Access to major insurance carriers
specializing in the senior living industry
Property and Casualty Insurance
Employee Benefts
Agency Risk Management Services
Safety Consulting
Claim Management
Human Resources Risk Management
For assistance, contact us at
1-800-242-7001
Kim Adey (ext. 833) Dave Hosack (ext. 859)
Scott Naze (ext. 817)
www.securityins.net
2725 South Moorland Road, New Berlin, WI 53151 3701 East Evergreen Drive, Suite 100, Appleton, WI 54913
FALL 2014 | CONTINUUM 11
Establishing a Prescription
Drug Formulary
New Law Allows Wisconsins Skilled Nursing
Facilities to Set up Formularies
By Kay Weidner, RPh, Extendicare and Greg Milanich, PharmD, HCR ManorCare
O
n April 16, 2014, Gov. Scott
Walker signed into law Wis. Act
294, giving Wisconsins skilled nursing
facilities the ability to establish drug
formularies. Formularies have been used
for many years by hospitals, managed
care organizations, prescription drug
plans such as Medicare Part D, and state
Medicaid programs as a way to control
cost, and promote safe and efcacious
use of medications. Physicians and
other prescribers are accustomed to
using drug formularies in a variety of
practice settings. This article discusses
the benets of a drug formulary and the
steps involved in establishing one within
the skilled nursing facility setting.
BACKGROUND
Wis. Act 294 refers to therapeutic
alternate drug selections, which
is another way of describing how a
drug formulary works. In essence,
a formulary is a list of various
therapeutic categories of drugs, where
one drug within each therapeutic
category is designated as the preferred
or formulary drug. Drugs within a
therapeutic category are chemically
different from one another, but can be
used to treat the same illness or disease.
A drug formulary should not be
confused with generic substitution.
A generic drug and its brand
equivalent are chemically
the same. Substitution
of the brand drug
for its generic
equivalent occurs
a u t o ma t i c a l l y
in most states,
i n c l u d i n g
Wisconsin. Pharmacists
are required to
automatically dispense
the generic when the
cost to the payer or consumer
is less than the
cost of the
brand name
drug unless
Clinical Corner
the patient or physician prefers the
brand name drug.
BENEFITS OF DRUG FORMULARIES
Formularies can be powerful tools for
controlling drug costs. They can be
used to promote safe and effective use
of medications by selecting drugs with
lower side effect proles, as well as offers
the potential for causing fewer adverse
reactions. In the SNF setting, some
drugs are chosen because they may be
better tolerated by the frail elderly.
Some medications are included on the
formulary because the dosage form can
be administered less frequently during
the day; a convenience for both patient
and nurse and create the potential for
fewer side effects. A formulary can
help determine which drugs should be
placed in the contingency box or back-
up supply of meds housed within the
nursing facility. It can also help assure
adequate stocking of these medications.
DEVELOPING A FORMULARY
A drug formulary within a skilled
nursing facility can be established
two ways. The law permits the
facilitys Quality Assessment and
Assurance committee to develop
written guidelines or procedures for
12 CONTINUUM | www.whcawical.org
Kathryn Weidner
JD, RPh, is
the Director of
Pharmacy for
Extendicare
Health Services,
and can be reached
at KWeidner@
Extendicare.com.

Greg Milanich,
PharmD, FASCP
is the AVP
of Pharmacy
Services for HCR
ManorCare and
can be reached at
gmilanich@hcr-manorcare.com
making alternate drug selections,
provided a pharmacist serves on
the committee. Alternatively, a
committee consisting of the Director
of Nursing, a physician, usually the
Medical Director, a pharmacist and
at least two other members of nursing
facility staff are able to develop the
written guidelines and procedures for
establishing the formulary.
The nursing facilitys consultant
pharmacist should play a key role
in formulary development in
collaboration with the provider
pharmacy. The consultant pharmacist
should be able to provide a list of
5-10 frequently or commonly used
therapeutic categories of medications,
where there are at least two, but
preferably more choices of drugs to
use within a category.
A good example is the class of drugs
known as proton pump inhibitors
(PPIs), used to treat acid reux and
GERD. There are many branded and
generic drugs within this category.
The consultant pharmacist should
be able to make a recommendation
to the committee after evaluating the
cost, safety or efcacy of each PPI.
Cost-savings can be determined based
on current and past utilization. The
safety prole and propensity for or
lack of adverse reactions should also be
considered as well as appropriateness
in the elderly population.
The consultant pharmacist presents
the list of preferred drugs within each
therapeutic category to the committee
members for discussion and approval,
explaining cost-savings potential,
and safety or efcacy benets of the
selected drug. The list should also
include dose conversions of the drugs
targeted for interchange. Once the list
of formulary drugs has been approved
by the committee, the nursing facilitys
Medical Director and Administrator
should document their approval by
signing a formulary document. This
is the nursing facility drug formulary.
WORKING WITH A PHARMACY TO
DETERMINE THE SPECIFICS OF THE
FORMULARY PROCESS
Work with your provider pharmacy and
consultant pharmacist to determine
the Medical Director and attending
physician formulary approval process
for their patients. One way to do this
is by having the Medical director and
all prescribers opt in by signing a
formulary document. An alternative
method is to have physicians opt out
by providing them notication of the
formulary and giving them the option
to request in writing to not participate
in the formulary for all of their
patients or on a patient by patient
basis. Include dose conversions on the
formulary document. Your pharmacy
should also assist in dening a method
of communicating to prescribers new
to order non-formulary medications.
For example, words such as no
formulary substitution or no
formulary interchange can be used
at the time the physician orders a
new medication, to indicate that the
physician wants the patient to receive
the non-formulary drug instead of
pharmacy switching to the alternative
formulary medication.
The pharmacy will help determine
how the switch to the formulary
medication will be communicated to
nursing staff. The pharmacy will then
help the facility determine nursing
staff responsibilities when a drug
interchange has been made. One
method is that pharmacy would attach
a document to the dispensed formulary
drug. This document, which could
also serve as a P.O. (physician order),
would alert nursing staff that there has
been an interchange to the formulary
medication, since the interchange
has been previously approved by the
prescriber. Nursing staff would need
to make any necessary changes to the
MAR. And as customarily done with
any new order, nursing staff would
communicate to the resident and/or
responsible party.
IMPLEMENTING THE FORMULARY
AND ONGOING REVIEW
Prior to formulary implementation,
nursing staff must be educated on
how the formulary will work. Your
consultant pharmacist should be able
to assist with this. Explain how the
pharmacy will notify nursing staff
when a formulary interchange is made
and the need to adjust the Medication
Administration Record (MAR) if
required. Post a copy of the formulary,
including dose conversions, at the
nurses station. Communicate to
pharmacy when physician approvals
occur and maintain a record of the
signed formulary document.
As a result of the fact that new brand
and generic drugs are frequently
being introduced on to the market,
the drug formulary will need to be
periodically revised. The consultant
pharmacist should take the lead
and propose changes to the QAA or
formulary committee, following the
same process that was used for the
initial development of the formulary.
FALL 2014 | CONTINUUM 13
A
gathering of assisted living
stakeholders on Nov. 30, 2009
produced a unique collaborative thats
getting the attention of state and
national provider community leaders,
as well as regulators and policymakers
from across the country.
Developed as a partnership between
the Wisconsin Center for Assisted
Living (WiCAL), the other assisted
living provider associations, and the
Wisconsin Department of Health
Services Bureau of Assisted Living,
the Wisconsin Coalition for
Collaborative Excellence in Assisted
Living (WCCEAL) is changing
the way the Badger State moves the
quality process forward.
WCCEAL is dedicated to
improving the outcomes of
individuals living in Wisconsin
assisted living facilities, including:
Community Based Residential
Facilities (CBRF), Residential Care
Apartment Complexes (RCAC),
and Adult Family Homes (AFH).
A comprehensive quality assurance
and quality improvement initiative,
WCCEAL is based on the premise that
when AL communities implement
internal quality assurance and quality
improvement throughout their
communities, they will have better
outcomes, and community residents,
staff and providers will all benet.
Theres been quite a bit of
attention by the national (provider)
associations, said Kevin Coughlin,
Collaborating for Quality
Wisconsin Coalition for Collaborative Excellence
in Assisted Living Rewards Quality
By John J. Vander Meer
Cover Story
Policy Initiative Advisor Executive
in the DHS Division of Long-Term
Care, who oversaw the development
of the program. We have met with
a representative from CMS who was
very supportive of WCCEAL. He
said if CMS is putting any barriers up
please let me know.
Coughlin said
ofcials in several
other states have
expressed interest in
Wisconsins model of
offering tangible and
intangible rewards
to providers who
demonstrate quality
outcomes through participation in the
WCCEAL, and data compiled by the
Center for Health Systems Research
& Analysis (CHSRA), which DHS
contracts with to help implement the
program.
Currently, were
working with the State
of Colorado to expand
this model to other
states, Coughlin said.
PEAL
The core of WCCEAL
is the implementation
of an association-
developed, department-
approved comprehensive
quality assurance, quality
improvement program.
For WiCAL, that program
is known as Performance Excellence
in Assisted Living (PEAL), which
focuses equipping providers with
recognized, foundational systems for
performance improvement. PEAL
draws heavily on the Baldrige Criteria
for Performance Excellence, with
facility quality committees at the
hub of the efforts.
When assisted living communities
and health care facilities implement
internal quality assurance and quality
improvement throughout their
systems, they achieve better outcomes
for their residents, and WHCA/
WiCAL will continue to make pursuit
of these efforts a priority, said Brian
Purtell, WiCALs Executive Director.
Part of the uniqueness of WCCEAL is
the recognition that there
are differing means
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In order to receive extended period
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Meet the existing criteria for
abbreviated survey based on
compliance history;
Be a member in good standing of
a major association;
Implement a provider
association and department
approved quality improvement
program that adopts standards
of practice, and is a member of
WCCEAL; and
Provide self-attestation of
substantial compliance of the
regulations.
QUALITY FOR ITS OWN SAKE
In its initial stages, Coughlin said
WCCEAL was designed with the idea
of allowing the BAL to better stretch its
regulatory resources given the limitations
on expanding the state workforce
to keep pace with the increasing AL
provider community. It has since
become a far more comprehensive
effort to provide facilities with the tools,
resources, and abilities to measure and
compare outcomes in order to enhance
performance improvement efforts.
While the carrot of potential regulatory
relief via less frequent surveys probably
initially catches AL providers attention,
the value in WCCEAL participation goes
well beyond regulatory considerations,
Purtell said. Frankly, I hope that
participation puts providers in a position
that they have little or no concern about
a surveyor review of their operations.
to achieve a common end. The four
associations approved programs vary
in design and implementation, creating
an environment for innovation and
even a bit of competition.

Quarterly, WCCEAL participants
submit quality variables including:
the number of falls with injury,
outbreaks of inuenza or norovirus,
and hospitalizations. These variables
enable providers to compare
themselves against their peers
and measure their own facilitys
performance over time. Annually,
all facilities conduct a uniformed
resident/family satisfaction survey.
The ability to both tangibly measure
the resident satisfaction in the various
areas of operations, and to compare
facility performance against
other participating facilities,
is a tremendous performance
improvement tool.
Participation in PEAL and
WCCEAL is helping realize
an exciting collaborative
vision for the future of assisted living in
Wisconsin, Purtell said.
For Carla Fus,
Manager of the
Gardens of Fountain
Way Assisted Living,
a CBRF in Menasha,
Wis, WCCEALs
collaborative nature
provides a new way
to attain the best
possible care for her residents.
WiCAL has provided support to all
its members and has provided us with
tools in each step of the process. The
quality improvement is challenging
and you have to be committed to the
program for it to work, Fus said. In
addition to developing a QA program
within our assisted living community,
another benet of participating in
WCCEAL is that the state recognizes
our facility is committed to quality
care. The facilities that participate and
are active with WCCEAL may have
the additional benet of less frequent
survey visits based upon past good
compliance and their participation.
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JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
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Final Survey Entry
& Review
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& Mailing
Continued on Pg. 26
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FALL 2014 | CONTINUUM 15
H
ow did your personal
experiences and professional
career path bring you to your
current position at the helm of
the Alzheimers Association, South
Eastern Wisconsin Chapter?
My professional path has involved a lot
of advocacy work. I spent 10 years at
United Cerebral Palsy back in the days
of getting people out of state institutions
and into the community, and then later
spent 13 years at Disability Rights
Wisconsin where I had the opportunity
to establish and build the rst
Milwaukee Ofce. In both positions I
learned a lot about putting together and
leading a strong team, and organizing
groups of people to take on systemic
change efforts. On the personal front, I
had polio as a ve year old back in the
epidemic days of the 1950s. My Mom
was one of the Mothers Marchers that
helped put an end to polio, and I would
love to be part of the end of Alzheimers.
Also, my grandmother passed from
vascular dementia and that left an
impression as well.
What do you consider to be the
primary role, challenges and
opportunities for your organization?
Our role is to beat Alzheimers
tomorrow, to help everyone dealing
with it today, and to raise concern
and awareness so no one goes through
it alone. One of the great things
Our opportunity is that everyone has been
touched to some degree by dementia,
and if it has not hit close to home yet,
unfortunately it will. I think our efforts
are helping to make Alzheimers disease
the number one public health issue in
the country. Another great opportunity
is that the baby boomers are among
our advocates they have been activists
throughout life and are demanding
action on Alzheimers.
In 2010 a taskforce created by
your organization issued its report
Handcuffed, which candidly
identied problems, explored
solutions, and recommended changes
for improving understanding, care
and treatment of individuals with
dementia. What effect has that report
had on public understanding of the
need for change in the Wisconsin
dementia care landscape?
Handcuffed and the follow up
report, We All Hold the Keys, were
intended to be our contributions to the
continuing dialog on how best to assist
people with dementia who exhibit very
difcult behaviors and are in need of
crisis services. Handcuffed was really
more of a description of what are often
broken, fragmented and under-funded
systems of care and response, while
We All Hold the Keys presented a
comprehensive road map of a better
approach. Both reports had inuence
because we managed to bring everyone
together around a big table, reach
consensus on critical issues, and put
forth recommendations that were
supported by all the key players. Our
rst ground rule was no one points
ngers and everyone rolls up sleeves
I think that kept the momentum for
change moving forward.
Our work also became part of bigger
forces. The Helen EF Appeals Court
decision quoted extensively
from Handcuffed, and after the
about being part of
the Alzheimers
Association is that we
are the global leaders
in the ght to end
Alzheimers through
research, but we are
also present in local
communities through
our care and support programs. The
challenge is of course the size and scope
of the Alzheimers epidemic. There
are 120,000 people with dementia in
Wisconsin now, but that will grow by
68 percent to more than 201,000 in
just 20 years. We are by far the largest
organization in the Alzheimers arena,
but we could literally double our size
tomorrow and still not reach everyone
with the disease or fund all the needed
research. So we have to grow boldly,
and our Association-wide strategic
plan is very ambitious.
Another huge challenge we face is the
stigma attached to Alzheimers. Stigma
often keeps people from seeking help
until the disease has progressed pretty
far. When Seth Rogan testied in
Congress on Alzheimers funding
he said the problem is that everyone
whispers about Alzheimers and we
have to stop the whispering. We need
to break stigma down, and some of
the best people helping us do that are
people with the diagnosis who are in
the early stages they are often our
best spokespersons.
Alzheimers Association, South
Eastern Wisconsin Chapter
Head Works with Providers
Executive Director Tom Hlavacek Works with
Provider Groups to Ensure Positive Outcomes
Q&A
Stakeholder Spotlight
Continued on Pg. 18
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FALL 2014 | CONTINUUM 17
lower court decision was upheld in
the Supreme Court, we asked for
the Legislative Council Special
Committee on Legal Interventions for
People with Dementia. Several Task
Force members played a role in the
Special Committee when it was
established. And then the draft
legislation we produced was not
supported by DHS Secretary Kitty
Rhoades, who asked instead for two
years to redesign dementia care in
Wisconsin. So in a way its possible to
draw a line from the establishment of
the Task Force to the development of
the State Plan.
Secretary Rhoades has clearly
made the redesign of Wisconsins
dementia care system a top priority
of her Department. What do you
consider to be the most glaring
gaps and deciencies in Wisconsins
current system that needs to
be addressed in the redesign
initiative? If you possessed a magic
wand what one thing would you
immediately change to improve
the current system?
We denitely support the efforts
of DHS and Secretary Rhoades to
develop and implement the Redesign
plan. When she came to the Legislative
Council Committee, she basically said
the problem is bigger than the scope
of the draft legislation, and she is right
about that. The Task Force, the Helen
EF decision, and the Legislative Council
were all focused on what happens at the
point of crisis, when what we need is to
get to the root causes before the crisis
develops in the rst place. This kind of
thinking is very much along the lines of
the road map we presented in We All
Hold the Keys.
We are very enthusiastic about almost
every aspect. Early identication and
awareness activities are much needed.
The expansion of the Dementia
Specialist program is going to help
many counties in Wisconsin better
coordinate care and services. We
also are very supportive of physician
outreach activities, working to increase
the dementia capability of managed
care entities and providers, efforts
to expand mobile crisis, and help
for counties to expand or establish
Chapter 55 placement capacity. There
are two areas where we would like to
eventually see more emphasis. The
rst is in the area of transportation
which is a huge problem for people
with dementia, especially in rural
areas. The second is a more explicit
focus on supporting family caregivers.
Part of the Dementia Specialist role is
to focus on family caregivers, but there
is a lot of need out there for support.
The long-term care provider
community has underscored that
Medicaid payment shortfalls and
exposure to civil and regulatory
liability stand as major barriers
that deter skilled nursing and
assisted living facilities from
admitting and providing ongoing
care to individuals with challenging
behaviors. Do you agree and, if
so, do you think the current DHS
redesign plan adequately addresses
these issues?
I certainly agree that our overall system
of publicly funded care for people
with dementia needs more funding,
and that it is increasingly difcult,
if not impossible, to nancially
sustain Medicaid-only facilities. I
also believe that as we continue to
better understand the dimensions
and scope of the services we will need
for people with dementia, we have
to think about how it gets paid for.
One example: as people continue to
live longer, those who have signicant
That said, I think the most glaring
current gaps and deciencies are in
the crisis response systems. The reason
we need to be stronger in this area
is because of the demographics we
face. We know from epidemiological
studies that about 120,000 people in
Wisconsin have Alzheimers, but we
also know from public health surveys
that over half are undiagnosed or
misdiagnosed. So its not a surprise
that we only learn about many people
with dementia at the point of crisis.
Most communities do not have a
mobile crisis capacity, or if they do, its
not 24/7 and many of the dementia
crises happen at night. We also know
that most counties do not have
capacity for Chapter 55 emergency
protective placements. This results in
situations where the rst people on
the scene are usually law enforcement
or other rst responders who may not
have dementia expertise, and even if
they do and they suspect dementia,
there is no designated crisis center
to take people to for both medical
care and behavioral treatment. The
person with dementia may wind up
being moved around a lot from
the local hospital emergency room
to a psychiatric crisis facility or to
another hospital or nursing home
and each of these transitions
cause transfer trauma and make the
behaviors worse. Secretary Rhoades
is completely right when she says
we need to create more community
awareness and identify people
earlier in the disease process, but
unfortunately we anticipate that for
some time we will continue to see a
lot of crisis situations.
DHS issued its nal redesign plan for
dementia capable Wisconsin in February
of this year. Which aspects of this plan
is your organization most enthusiastic
about? What, if any, components or
omissions of the proposed plan cause
you the most concern?
Stakeholder Spotlight Continued
Continued on Pg. 20
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FALL 2014 | CONTINUUM 19
behavior issues will need intensive
services for longer periods of time
than at present. In addition, for people
like that who have been through the
Chapter 55 legal process and are now
on public funding, very few providers
are willing to try to serve them at
todays reimbursement rates. And yet
everyone agrees we will have more of
these folks to care for.
We addressed the issue of
regulatory exposure in the
Taskforce reports, and have tried
to stimulate additional dialogue
between surveyors and providers
about some way to treat people
with difcult behaviors in place
and avoid care transitions, which
is clearly the best practice in the
literature, while at the same time
allaying fears and exposure regarding
code violations. The DHS Plan does
not specically address this issue
yet, but on paper it says we need to,
which is a step in the right direction.
In terms of funding, I think its
also important to remember that
we all have a role to play in
advocating for more resources.
The Alzheimers Association plans
to be very vocal on a number of
funding issues in the 2015 State
budget process.
WHCA/WiCAL has expressed
reservations that the goals and
objectives of the Dementia redesign
effort cannot be achieved without a
commitment to provide increased
public funding and resources in
the next state budget? Do you share
these concerns?
We welcome the opportunity to
develop and advance shared advocacy
priorities with you.
In recent months there has been
positive news regarding Alzheimers
screening and treatment using
We wrote an amicus brief supporting
the lower court ruling when the
Supreme Court deliberated on
Helen EF so that tells you where
we stand. Clearly Chapter 55 is
the better statutory framework for
both emergency and permanent
protective services for people with
Alzheimers. We at the Alzheimers
Association are also the group that
asked for the establishment of the
Legislative Council Committee
on Legal Interventions for Persons
with Dementia, so yes, we thought
statutory changes were needed.
In the draft legislation, I think
breaking out dementia into its own
sub-chapter made sense, as did the
denition of the Dementia Crisis
Units counties would need to identify.
I understand the rationale in Ch. 55
that commitments should not be
made to psychiatric facilities, but
the reality is that we have some very
good psychiatric facilities that provide
top-notch geriatric crisis care, and in
the draft legislation a county could
have designated such a facility as a
Dementia Crisis Unit, as long as they
could meet other criteria. I thought
that was a positive step.
Where DHS and the Alzheimers
Association are in total agreement
is that the very fewest number of
people possible should have to go the
legal route to obtain help, and that
is why we are in total support of the
broader systems redesign envisioned
in the Plan for a Dementia Capable
Wisconsin. In a way its a trade-off
but one I am happy as an advocate to
accept. Also, I take DHS at its word
that if statutory changes are still seen
to be needed they will be open to that.
cataract surgery and music therapy.
What does this news mean for the
community ghting Alzheimers
disease?
The two Holy Grails that are out
there for breakthroughs are in the
areas of biomarkers and effective
treatments. We know dementia
begins to form in the brain as much
as 20 years before the onset of
symptoms. The goal is to identify
and treat it early. To do that we need
a simple biomarker, like cholesterol
is for heart disease, to identify the
people most at risk for Alzheimers.
We had some very promising news
in July about a simple eye test
that can detect Alzheimers related
changes in the retina. Researchers
are also pursuing blood and genetic
tests that could become available
soon. Many avenues are also being
studied for an effective treatment
and increasing evidence is pointing
to lifestyle changes that can make a
big difference. So we get closer all
the time. In terms of music therapy, I
cant say enough about the Music and
Memory Program from the State of
Wisconsin. We are very pleased it is
being expanded and helped to gather
donated iPods though our Walks to
End Alzheimers this fall.
With the Wisconsin State Supreme
Court decision in the Helen
EF case limiting certain emergency
procedures for individuals with
dementia, legislation has been
developed to make certain changes
to the statutes. While DHS has
opposed the legislation in favor
of the its larger initiative, do you
support the legislative effort to
address the Helen EF decision?
Generally, what do you believe
to be the proper course for those
who face challenging behaviors
that sometimes are associated with
individuals with Alzheimers or
related dementia?
Tom Hlavacek is the Executive
Director for the Alzheimers Association
of Southeastern Wisconsin. He can be
reached at thlavacek@alz.org.
Stakeholder Spotlight Continued
20 CONTINUUM | www.whcawical.org
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FALL 2014 | CONTINUUM 21
R
outine review of policies and
procedures is an important
step in compliance and performance
improvement efforts. Review of a
facilitys policies and procedures
regarding admission, identication of
current and prospective legal decision-
makers, and identifying resident current
and advance care planning wishes,
are critical steps for skilled nursing
and assisted living facility providers.

Here are ve reasons providers may
wish to put a review of their current
policies and procedures related
to admission, decision-maker
identication, and advance care
planning identication on their
quality committee agenda.
1. RECENT REGULATORY INTERPRETATIONS:
Skilled Nursing facility providers
should be aware of two regulatory
developments that may impact
current practices. CMS S&C 14-
01-NH, followed quickly by DQA
memo 13-022, articulate that all
federally certied skilled nursing
facilities must have staff certied in
CPR on duty every shift, and these
individuals must provide CPR for any
resident who becomes pulseless and
non-breathing unless (1) the resident
has a DNR order; (2) the resident
has obvious signs of clinical death or
(3) the initiation of CPR could cause
injury or peril to the rescuer.
Incorporating this analysis as part of
the quarterly MDS process and at the
time of a change of condition would
be a means to assure ongoing review.
Assisted living providers should similarly
be aware of the Bureau of Assisted
Livings heighted attention to CPR
policies. While there is less prescriptive
expectations, AL providers are being
asked to more explicitly articulate their
policies regarding whether, when and
how CPR will or will not be provided.
Licensure applicants are expected to
include this information as part of the
application process, and it has been
stated that limitations on the provision
of CPR should be included within
program statements.
2. STAFF SUPPORT: Often lost in the
discussion of advanced care planning
is the impact that insufcient
policies and procedures can have
on staff members. It is important
to have clarity with regards to staff
expectations and that systems are
in place to clearly identify residents
wishes, particularly regarding the
provision or withholding of CPR and
hospitalization. Arming staff with the
knowledge of what action is to be
taken is critical to avoid individuals
being placed in the terrible position
of uncertainty during an emergency
situation. While assuring staff
condence of action expectations
provides comfort that they are acting
consistent with the desires of the
resident, it can also protect these
individuals from individual licensure
or other exposure.
3. FAMILY SUPPORT: Having a process
that stimulates an informed and
comprehensive discussion upon
admission, and throughout a residents
stay, provides family an opportunity
to become comfortable with decisions
made by or on behalf of residents.
LTC Legal Letter
Top-5 Reasons Providers
Need to Review Advance
Directives
Policies, Procedures and Forms Critical for
Wisconsins LTC Providers
By Brian Purtell
These memos explicitly prohibit
federally certied skilled nursing
facilities from adopting a no CPR
policy. Even facilities that did not have
such policies should assure the stated
expectations are in place, particularly
policies that instruct staff to withhold
CPR for unwittnessed arrests for full
code residents.
Skilled nursing facility providers
should also be mindful of the
increased expectations found in
the fall 2012 update to the F155
Guidance to Surveyors. That update
reiterated a residents right to establish
advanced directives and to accept
or decline treatments, and places
signicant emphasis on a residents
self-determination rights. In addition,
the clear expectation is for advanced
care planning discussions to be an
ongoing dialogue, rather than simply
one upon admission.
Providers should therefore review
their current practices to assure
clarity upon admission as to (1) the
presence or absence of advanced
directives; (2) the authorized decision
maker, and their authorities; and (3)
the wishes with regards to treatment
options, including the provision of
CPR, at the time of admission. As
importantly, these should be reviewed
on a regular basis to assure that they
are reective of the residents current
wishes in light of their condition.
Continued on Pg. 24
22 CONTINUUM | www.whcawical.org
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FALL 2014 | CONTINUUM 23
Education, well beyond forms to
complete, including risks and benets
associated with decision options can
minimize future conict or anxiety.
As important, particularly for assisted
living providers, communicating
what care and services can and will
be provided by facility staff versus
summoning emergency personnel
should be explicitly communicated as
part of the admission process. If facility
staff do not provide CPR, it is imperative
that family members understand this
limitation, as expectations and reality
may be very different.
4. RISK MANAGEMENT: Absence of clear
policies, systems and training, have
resulted in signicant regulatory
that an individuals wishes are followed
is paramount. Review of your current
policies and procedures will assure that
residents wishes or best interests are at
the forefront. Patient self-determination,
particularly for those individuals who
may have lost many aspects of autonomy,
should be respected to the utmost degree.
enforcement against skilled nursing
and assisted living facilities. Staff
withholding resuscitation from full
code residents due to confusion or
inaccurate information has been
the source of several signicant
regulatory actions. Conversely,
providing treatment contrary to
expressed wishes can also be a
source for regulatory and civil
liability. Compliant policies and
procedures, based upon recognized
standards of practice and ongoing
monitoring, provide important risk
management measures.
5. RESIDENT WELFARE: While the
above are signicant reasons to assure
clarity, ultimately the goal of assuring
Brian Purtell is the
Director of Legal
Services for the
Wisconsin Health
Care Association and
the Wisconsin Center
for Assisted Living,
and the Executive
Director of the Wisconsin Center for
Assisted Living. He can be reached at
bpurtell@whcawical.org.
A
d
v
a
n
c
e D
ir
e
c
t
i
v
e
s
Power of
Attorney for
Health Care
Declaration
to Physicians
(Living Will)
Do Not
Resuscitate
Order (DNR)
Physicians
Order for
Life
Sustaining
Treatment
(POLST)
LTC Legal Letter Continued
24 CONTINUUM | www.whcawical.org
Wisconsin Center for Assisted Living Wisconsin Health Care Association
JOIN
If you Operate a Skilled Nursing or Assisted Living
Facility, Experience the WHCA/WiCAL Dierence!
Strong & Eective Legislative Advocacy
Discounts on Quality Educational Programming
Eective Quality Improvement Programming, Resources
& Assessment Tools
Seasoned Legal & Regulatory Counsel
www.whcawical.org/join
Advocacy | Education | Excellence
Purtell encouraged
the manager of
any assisted living
facility interested
in participating in
PEAL to contact
him for more
information. He
can be reached at
bpurtell@whcawical.org.
WCCEAL has given me the tools
to identify trends in my facility and
identify what areas in which to make
improvements on, Fus said. I have
learned to approach quality improvement
and not be so overwhelmed. At rst, all
the information to develop a quality
program seemed so overwhelming and
it would take so much time to develop
and see results.
Fus said that WCCEAL offers her
facility a satisfaction survey her staff can
offer their residents, and allows them
to compare Gardens of Fountain Way
Assisted Living with other AL providers.
These tools help me develop
benchmarks for our facility and nd
areas to improve care, Fus said.
In fact, Coughlin said the program has
changed the nature of the relationship
between member facilities and
their provider association. Now an
association such as WiCAL can assure
that participating members properly
implement the program, and is
involved in helping member facilities
attain a level of quality care.
The uniqueness about this
collaborative is the relationship
between the association and their
members, so they can intervene
before it becomes a regulatory issue,
Coughlin said.
Ultimately, Coughlin said the
importance of the program for
consumers is that the program will
offer a new standard that is more
universally accepted by different
perspectives in long-term care.
As this program moves from being a
pilot, it will really establish a brand of
excellence, said Coughlin, who said that
the Department examines, in anonymous
form, resident satisfaction, falls, hospital
readmissions, infection, staff vaccinations,
occupancy, regulatory compliance.
WCCEAL RESULTS AND ITS FUTURE
As WCCEAL has continued its
development, Coughlin said hes seen
benets beyond what he originally
anticipated. Coughlin said he has
received reports from participating
facilities that their insurance companies
have begun providing discounts.
Coughlin said that the initial ndings
of facilities that are participating in
WCCEAL are showing greater regulatory
compliance and quality outcomes.
We are seeing a high degree of resident
satisfaction in the areas of stafng,
resident rights and safety, activities,
meals and health management,
Coughlin said of participating facilities.
With the continued support of providers
and stakeholders, Coughlin said he
sees opportunities for the growth and
development of quality improvement
efforts resulting from WCCEAL.
With the different stakeholders that
are involved, the national attention
and the possibility of adoption in other
states, I think the future is very bright
for the WCCEAL program, he said.
In fact, CHSRA was recently awarded
a $150,000 grant that from the
Institute for Clinical and Translational
Research to continue deploying the
program, Coughlin said.
Moreover, Coughlin said on-going
interest by Wisconsins managed care
organizations, may pave the way for
using participation in WCCEAL as a
mechanism for demonstrating quality
improvement.
We really want this to be a standard
of excellence. We hope to make this
a brand of a standard of excellence,
Coughlin said. We want to see
that (WCCEAL) goes beyond our
borders and that we see sustainability
of this program.
Create a Public/Private collaboration with provider associations to develop a comprehensive
quality improvement & quality assurance program and to help their members to be successful.
Collaborate with the Center for Health Systems Research & Analysis (CHSRA) to improve long-term care and
health systems by creating performance measures and developing information and decision support systems.
Provide regulatory relief for high-performing assisted living communities.
Dene the level of excellence that will be recognized by public funding agencies, insurance
companies, assisted living communities, advocates, legislators, general public and other key
stakeholders.
W
C
C
E
A
L

G
O
A
L
S
Cover Story Continued
John J. Vander
Meer is WHCA/
WiCALs Director of
Communications.
He can be reached at
john@whcawical.org.
26 CONTINUUM | www.whcawical.org
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