Continuum Spring 2015

2015 MEMBER DIRECTORY ENCLOSED
Spring 2015
Wisconsin Health Care Association
Wisconsin Center for Assisted Living
131 W. Wilson Street, Suite #1001

Madison, WI 53703
A publication for Wisconsins Long-Term Care Profession by
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The Caregiver Shortage

Low Reimbursement, Competition,
Regulatory Climate Limit Workforce
Attend the WHCA/WiCAL Spring Conference at Kalahari Resort April 15-17. See you there!
Including:
ICD-10: Ready, Set, Code
Co-Chairs of the Joint Finance Committee Comment on the Budget Process
Medical Record Requests: Who Gets What and When?
ANALYZE
Welcome
Make Your Voice Heard!
WHCA/WiCALs
The Spring 2015 issue of Continuum is being released

as a part of the 2015 WHCA/WiCAL Legislative Day.
On Legislative Day, WHCA/WiCAL members fan out
into legislative offices of the Wisconsin State Capitol
to share the stories of Wisconsins hard working skilled
nursing and assisted living facility employees.
OVER 25 YEARS SERVING SENIOR CARE FACILITIES
However, Wisconsins long-term care providers

cant limit their advocacy to one day out of the year.
Throughout the year we need to show Legislators in our
facilities how Wisconsins long-term caregivers provide
exceptional care to the Badger States frail elderly
and disabled on a 24/7/365 basis, despite the limited
resources the state provides in Medicaid reimbursement.
We need to explain in letters, calls and emails that times
are changing Between 2011 and 2029 about 8,000
members of the Baby Boomer generation will turn
65-years-old every day. Now is the time to ensure that
Legislators get our message that in order to maintain
the quality of care Wisconsins consumers have come
to expect, state leaders need to invest in our LTC
workforce.
Website planning and strategy

Budget-friendly design options
In this issue of Continuum, WHCA/WiCAL provides

Wisconsins LTC provider community three articles
that offer background on the stakes in the 2015-17
Biennial Budget. In Capitol Connection, we breakdown
the budget process and the legislative climate in the
State Capitol. The Cover Story for this issue highlights
the importance of reimbursement for the training,
recruitment and retention of certified nursing assistants
(CNAs). Finally, in Stakeholder Spotlight, the Co-
Organic search engine optimization

Copywriting and photo support
Social media and email marketing support
DESIGN
DEVELOP
ENHANCE
Chairs of the Legislatures powerful budget-writing

committee, the Joint Finance Committee share their
thoughts regarding the budget process.
In the other sections of the magazine: the LTC Legal
Letter explains the who, what, and when of long-term
medical record compliance; Media Matters offers an
explanation of social media marketing; and finally in
Clinical Corner, WHCA/WiCALs on-line education
partner, CE Solutions explains some of the background
on the upcoming change to ICD-10.
With the Spring 2015 Issue of Continuum, we are
also pleased to provide a copy of our 2015 WHCA/
WiCAL Membership Directory. WHCA/WiCAL
offers this Directory to membership, other long-term
care providers, policymakers and the public as a useful
resource and roadmap for locating our member LTC
facilities in Wisconsin.
As always, thank you for taking the time to read
Continuum, and please be sure to contact your
state Legislators in the coming weeks regarding the
importance of funding for Wisconsins LTC provider
community. We need your voice to make a difference.
Sincerely,
Tom Moore
Executive Director
WHCA
Brian Purtell
Executive Director
WiCAL
Learn How YOU can Help! www.whcawical.org/budget

@ Kalahari Resort
in the Wisconsin Dells
DEPLOY
Call 800-448-5213 or visit www.illuminage.com for more information and to discuss your needs.
2015 Spring
Conference Date
April 15-17
53ANNUAL
rd
SPRING CONFERENCE
AND EXPOSITION
Register: www.whcawical.org/spring
Spring 2015 | CONTINUUM 4
Advertiser Index
2
4
4
and
ASSOCIATES
JT and Associates, LLC

Accounting, Tax & Advisory Services
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BILLING SERVICES
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IlluminAge
JT and Associates
Bluestone Physician Services
Specialized Medical Services, Inc.
McKesson Medical
Marsh & McLennan Agency
OConnell LTC Pharmacy
Care Classic
New Horizon Foods
Alea Training
Badger Graphic Systems
Siesennop & Sullivan
American Way University
Navigator Group Purchasing Inc.
Martin Bros. Distributing Co. Inc.
Wipfli
Health Direct Pharmacy
MJ Care
CE Solutions
M3 Insurance Solutions
Spring 2015
Contents
6
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
Creative Director
Sara Rice
10
12
14
Bluestone Physician Services provides on-site primary care services for residents living in assisted living, memory care
or group home communities. The physician-led care teams visit the patients on a regular basis and collaborate with the
facility staff and patients family to provide customized medical care.
Call 262.354.3744 or visit BluestoneMD.com to learn more.

5 CONTINUUM | www.whcawical.org
2015 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.
CLINICAL CORNER
ICD-10: Ready, Set, Code
Providers Expected to be Ready October 1, 2015
COVER STORY
Low Reimbursement, Competition, Regulatory Climate Limit Workforce
Long-term care professionals often say that the most difficult job in a skilled nursing or
assisted living facility is the role of a certified nursing assistant (CNA) or other front-line
caregiver. Caring for frail elderly and disabled residents is challenging work that requires
patience, a positive attitude and frequently a strong back and heart. Many CNAs say
working with their residents is very rewarding; yet with a median CNA wage of $12.39/
hour, those rewards dont translate into competitive take-home pay. However, with the
State of Wisconsin ranked as the second-worst Medicaid reimbursement system in the
country, long-term care providers are often unable to provide wage rates that retain
qualified CNAs in positions critical to maintaining quality care for residents.
16
For more information in advertising in

Continuum call 608.257.0125 or go to
www.whcawical.org/continuum.
Bringing the Clinic to YOU.
Social Media Presents Marketing Opportunities for Long-Term Care
Beginning October 1, 2015, the ICD-10CM (diagnosis) codes will be used for all health care
settings with the exception of inpatient hospitals which will use the ICD-10PCS (procedure)
codes. This is of importance for those health care providers that work with workmans
compensation companies.
Published by
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.
MEDIA MATTERS
Using New Media to Attract New Clients
Facebook. Twitter. Instagram. You may use these tools personally, but now youre being
challenged to use these tools as part of the marketing strategy for your facility. Youll also
understand why you can no longer afford to ignore social media.
Layout & Design

David Cox
1155 Wilburn Road

Sun Prairie, WI 53590
608.834.3400
www.bgsinc.com
Cabinet Members Appointed, Legislative Committees Assigned, and Budget Debate Begins
The initial 6 months of every new session of the Legislature is focused on the Governors
proposed biennial budget bill. The Board of Directors has directed WHCA/WiCAL staff
to prepare issue papers relating to the Governors proposed budget bill, which included
Medicaid and Family Care funding, significant changes in Family Care, workforce shortages,
transportation of residents, and a history of the bed tax to be shared with all Legislators.
Editor
Melissa Keller
Account Manager
Abbie McDowell
CAPITOL CONNECTION
2015-16 Biennial Session of the Wisconsin State Legislature
STAKEHOLDER SPOTLIGHT
Co-Chairs of the Joint Finance Committee Cut Through State Budget Process
Co-Chairs of Powerful Joint Finance Committee Address States Medical Budget
Senator Alberta Darling (R-River Hills) and Representative John Nygren (R-Marinette), CoChairs of the Joint Finance Committee, have introduced SB21/AB21, the proposed 201517 biennial budget bill at the request of Governor Walker. The bill(s) have been referred
to the Joint Finance Committee which will conduct a series of public hearings, meet in
executive session to vote on the Governors initiatives, then message the bill both Houses of
the Legislature for final approval. The Co-Chairs review the issues and their responsibilities.
22
LTC LEGAL LETTER

Medical Record Requests: Who Gets What and When?
Clear Processing Procedures Needed to Limit Regulatory Exposure
The time to identify who is entitled to what portions of a residents record is not when a
request is presented. SNF and AL providers should identify what constitutes a record,
the rules about who, besides the resident, is entitled to all or part of a record, and the
process to be followed by the requestor and facility personnel.
PUBLISHED MARCH 2015
Capitol Connection
2015-16 Biennial Session

of the Wisconsin State
Legislature
Cabinet Members Appointed, Legislative

Committees Assigned, and Budget Debate Begins
By Jim McGinn
he November elections last year

maintained the political power in
Wisconsin State government with the
Republican Party as Governor Scott
Walker was reelected and the State
Senate and Assembly increased their
majorities in both Houses.
A brief review, Governor Scott Walker
defeated Democratic candidate Mary
Burke with 52% of the vote, marking
the third election of Governor Walker
in the past 4 years.
In
the
33-member
Senate,
Republicans continue in the majority
and control the Senate, 19-14, an
increase of one seat from last session.
Senator Scott Fitzgerald (R-Juneau)
again leads the Senate as Majority
Leader and Senator Mary Lazich
(R-New Berlin) serves as Senate
President. The Senate Democrats are
led by Minority Leader Jennifer
Shilling (D-LaCrosse) and Assistant
Minority Leader Dave Hansen
(D-Green Bay).
The states operating

budget for 2015-16 is
budgeted at $35.938
billion (all funds),
a 2.6% increase over
the previous year.
In the 99-member State Assembly,

Republicans also increased their majority
by three seats margin to 63-36. Assembly
Speaker Representative Robin Vos
(R-Rochester) is the presiding officer of
the Assembly and supervises all other
officers of the chamber and appoints
committee chairs. Representative
Jim Steineke (R-Kaukauna) serves as
the Majority Leader. The Assembly
Democrats are led by Minority Leader
Peter Barca (D-Kenosha) and Assistant
Minority Leader Katrina Shankland
(D-Stevens Point).
Shortly after his election, Gov. Walker
announced his Cabinet for the 201516 Legislative session. Pleased with
the leadership of his Secretaries, the
Governor reappointed both Department
of Administration Secretary Mike
Huebsch and Department of Health
Services Secretary Kitty Rhoades. DOA
Secretary Huebsch is currently assisting
the Governor with the proposed 201517 biennial budget bill, with DHS
Secretary Kitty Rhoades focusing on
Medicaid funding and massive changes
to the Family Care program in the
budget bill.
Effective March 1, Gov. Walker
announced that DOA Secretary
Huebsch was appointed to serve on the
Public Service Commission and Scott
Neitzel, an executive at Madison Gas
and Electric, will serve as his Department
of Administration Secretary.
Following inauguration ceremonies,

Gov. Walker delivered his State of the
State address to a joint session of the
Wisconsin Legislature on January 13.
The Wisconsin Constitution requires
the Governor to communicate to the
legislature, at every session, the condition
of the state, and recommend such
matters to them for their consideration
as he may deem expedient.
Focusing on a Wisconsin Comeback,
the Governor reported that more
people are working today while
fewer are unemployed and there are
now 7,600 more private sector jobs
in Wisconsin than there were before
the recession. The Governor also
noted that over the past 4 years, the
Legislature and his Administration
have reduced the tax burden by $2
billion and property taxes on a typical
home are $141 lower in December
2014 than they were four years ago.
With respect to specific proposals,
the Governor asked the Legislature
to pass legislation to: 1) ensure
objective information is available for
every school receiving public funds;
2) stipulate that no school district
is required to use Common Core
standards; and 3) combine four state
agencies to two.
As with most State of the State
messages, few details were provided
on budget issues which the Governor
addressed on February 3, in his
budget address to a joint session of
the Legislature.
Identifying his 2015-17 biennial
budget proposal as his Freedom and
Prosperity budget, Gov. Walker stated
that his plan is based on growth and
opportunity, which leads to freedom
and prosperity for all. The Governor
further commented that his budget
plan includes common sense reforms
to create a government that is limited in
Continued on Pg. 8
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Capitol Connection Continued

the nation without a gap in coverage,
according to the respected Kaiser
Family Foundation.
previous year and at $32.347 billion

(all funds) in state fiscal year 2016-17,
a -10% decrease.
Other initiatives Gov. Walker

highlighted included expanding the
requirement for able-bodied adults
to be enrolled in employment and
training programs and require those
adults without children to pass a drug
test in order to get a welfare check.
Similar to his State of the State

address, specific details were limited
in the Governors address, however,
it is very clear the budget includes
no funding increases for skilled
nursing facilities or other Medicaid
or Family Care providers. While
budget officials have confirmed they
project increases in skilled nursing
facility resident acuity over the next
2 years, they also acknowledged the
2015-17 biennial budget bill does
not provide funding for acuity.
Wisconsins GPR (general purpose

revenue-or
state
tax
dollars)
contribution for the operating budget
is $15.875 billion in 2015-16 and
$16.943 billion in 2016-17. State
GPR contributes 52% to the operating
budget, with the federal government
contributing 28%, segregated funding
(gas tax) contributing 12% and program
revenue (license fees) contributing 8%.
While not providing details, the

Governor stated that in this budget,
we put more than $600 million into
Medicaid to provide health care for
needy families, children and seniors.
Through our bold reforms, among the
states that did not take the Obamacare
expansion, we are the only state in
The Department of Administration

released a 91-page Budget in Brief
shortly after the Governors speech.
The following provides a brief overview
of the Governors proposed budget:
The states operating budget for 201516 is budgeted at $35.938 billion
(all funds), a 2.6% increase over the
scope and ultimately more efficient,

and more accountable to the public.
Gov. Walkers proposed budget
continues the tuition freeze for
undergraduates from Wisconsin at
each of the UW-System campuses and
adds a tuition freeze in our technical
colleges for high demand jobs.
The largest increase in GPR funding in

the Governors biennial budget is $663
million to the Department of Health
Services (Medicaid), followed by a $200
million increase to shared revenues and
tax relief, $44 million to the Department
of Public Instruction and $53 million
for other programs. The Department of
Administration notes that compared to
the base budget, this increase (Medicaid
and Badger Care) totals $657 million
GPR over the biennium. The largest

factors in this increase are the result
of routine caseload, inflation and
utilization changes.
Capitation payments to Family Care
MCOs are increased by 3.2% in
2015-16 and by 2.5% in 2016-17.
With limited information and more
information to follow, the Governors
budget recommends expanding
Family Care statewide and transitions
the program to a new model providing
long-term care, primary care and
acute care services to participants
through managed care organizations
operating statewide.
The Governors proposed budget
also includes an elimination
of the Any Willing Provider
requirement. To promote enrollee
choice of providers, current law
requires Family Care MCOs to
contract with any provider willing to
accept the MCOs payment, service,

and contract expectations. The
proposed budget would eliminate
this provision and permit Family
Care MCOs to restrict what entities
will be allowed to participate in their
respective provider networks.
Public hearings of the Legislatures Joint
Committee on Finance are scheduled
for the following dates and locations:
March 18: Brillion High
School (Calumet County,
east of Appleton on Hwy 10)
March 20: Alverno College
in Milwaukee
March
23: UW-Barron
County (Rice Lake)
March 26: Reedsburg High
School (Sauk County, west
of Baraboo)

Again, the Governors budget includes

no proposed rate or acuity increases
for skilled nursing facilities, and
no requirement for an increase for

Family Care providers.
WHCA/WiCAL calls on all of its
membership to contact their State
Representatives and State Senators
to advocate for increasing provider
reimbursement. Legislative advocacy
is critical to shaping the forthcoming
state budget. Members are needed
to advocate for their residents, staff,
family members and the long-term care
provider community.
For more information on how you can
make sure your voice is heard in Madison
go to www.whcawical.org/budget.
James McGinn
is WHCA/
WiCALs Director
of Government
Relations. He can
be reached at
jim@whcawical.org
Serving Facilities in South Central WI

125 S. Thompson Rd. | Sun Prairie, WI 53590
Phone: (608) 837-8002 | Fax: (608) 837-8005
During the 2013 WHCA/WiCAL Legislative Day, Greenway Manor Administrator Mark Scoles and then-State Representative
Howard Marklein (R-Spring Green) met to discuss critical issues facing Wisconsins long-term care providers. In 2014, Marklein
was elected to serve the 17th State Senate District, and was selected to be one of the 16 members of the Legislatures budget-writing
Joint Finance Committee.
www.oconnellpharmacylongtermcare.com
Going the extra mile is our way of doing business!
Media Matters
Using New Media to

Attract New Clients
Social Media Presents Marketing

Opportunities for Long-Term Care
By Adrianne Machina
ave you incorporated social

media marketing into your
overall marketing strategy? If you
havent embraced social media fully,
whats holding you back?
Social media provides a fantastic
opportunity to market your facility.
Social media:
Can displace expensive print
ads;
Can be done by almost anyone
doesnt require advanced
skills;
Turns your best clients into
referral sources;
Enables family members to selfeducate about their options;
Provides
comfort
and
reassurance to family members
theyve made a good decision;
Can continually attract new
residents and new employees;
Reinforces family connections
even when geographically
separated.
With all that upside, why wouldnt
you want to use social media?!
Well for sure, theres a risk, just like
theres a risk in anything you do.
You have to stay in compliance
with laws like HIPPA.
You have to embrace doing
things differently.
You have to train your staff
and set guidelines.
You have to be prepared to
deal with negative review
and criticism.
Social media requires adapting your

ways, but this is the new standard.
The world has shifted. Its time you
shift your marketing to adapt to
this new reality. People expect to be
able to stay connected, to be able
to find reviews and to peer through
your windows virtually before they
ever walk in your door or talk to
your intake professionals. It may feel
scary and overwhelming at first, but
thats why weve dedicated an entire
afternoon on April 15, during the
53rd Annual WHCA/WiCAL Spring
Conference to discuss your concerns

and help you set a path for success.
According to a Nielsen study,
92% of consumers trust the
recommendations their friends and
family. Social media is like word of
mouth on steroids. You can create
an endless stream of referrals by
connecting with the right people on
Facebook, Twitter and LinkedIn. You
can promote your facility and brand
by continually publishing content
on YouTube, your blog and photo
sharing sites.
TECHNOLOGY ISNT RESERVED FOR
THE YOUNG
While your residents may not be
tweeting and reading blogs, their
families are. The largest growing user
base of social media is aged 55+. And
in addition to clients, your referral
sources are online. You can connect
with geriatric doctors and social
workers. You can promote events

and build a tribe of people whose
commitment to care aligns with
yours. One of the stats that continues
to shock people is the fact that 100%
of Internet users consume social
media. That doesnt mean everyone
is on Facebook or Twitter, but it does
mean that anyone doing an Internet
search is highly likely to come across
a video, article or picture posted by
the general public. The challenge is
to be in the right places and to be
actively listening, and participating
so you can present yourself favorably.
SOCIAL MEDIA STARTS WITH A
STRATEGY
One of the biggest challenges that
new social media managers face is
figuring out what theyre going to
talk about. Before you launch your
online efforts, you need to start with
a strategy. What are you trying to
accomplish? What are you going to
say? How are you going to continually
find new things to share? What is the
perception you want people to have
about your facility?
Lets start with what NOT to do.
First of all, I want to make sure
you understand that theres a
fundamental difference between
your social media pages and your
website pages. Your websites pages
are filled with information about
your services, and your people. Dont
repeat that same information in your
posts. Social media is not intended
to be one long sales pitch about you.
If your message is on target, and
your readers like what youre saying,
theyll go visit your website pages
and subscribe to your newsletter. Do
your selling there.
You must resist the urge to make
every blog and social media post
about how awesome you are. Instead
communicate about a subject
of interest to the people you are
trying to reach. Create content that

informs and educates and entertains.
SO WHAT DO WE WRITE ABOUT?
You want to keep your posts focused
on reaching one specific target
audience, but dont be afraid to
get creative! The content you post
on social media should be about
connecting with your families. Think
about the position that your target
is in and post content that can help
to aid or reaffirm the decisions they
make. For example, upload YouTube
videos that give advice for how to
talk to your relatives about long-term
care options, or use your Facebook
page to post updates on community
events or news about resident
activities. Again, put yourself in your
target customers shoes. What would
you want to see on a long-term care
blog or Twitter feed?
HERES 3 QUICK TIPS TO GET SOME
IDEAS FLOWING:
News Stories
Are there new government or
insurance regulations that impact
long-term care? What states are the
best for assisted living? Are there
new best practices in care? Has there
been a break through with a new
Alzheimers therapy? Use stories like
these and add your opinion to really
make it your own. Remember, you
can use content you find on the
Internet, as long as your provide
a link to the source material and
proper attribution.
Human Interest Stories
Share touching stories that others
have created. Inspire people to
live their best lives today. Show
vibrant people in their 80s and 90s
and people who have overcome
disabilities to live amazing lives.
Client Stories
Posting updates like Today is
Arts 80th birthday! or Check out
who just won at Bingo Night! is a

great way to keep family members
connected with their loved ones.
Of course, you have to be mindful
of privacy concerns and personal
preferences, but many family
members appreciate getting to see
what goes on inside your community
and what their loved ones are up to.
Again, your focus is on connecting.
These
stories
illustrate
that
committed and concerned about
your clients well-being.
While your residents

may not be tweeting
and reading blogs,
their families are.
The tone and intent of what you
post should be to educate, attract,
and inspire. You decide what format
and voice that will take. Social media
is here to stay, and more mainstream
than ever. You may not have Nikes
marketing budget, but you can steal
their slogan JUST DO IT!
Well be covering social media in
great depth at the social media can
be an extremely effective, loyaltyinspiring, low-cost way to reach
capacity and make your residents and
their families a fan of your facility.
Adrianne Machina
has spent nearly
20 years helping
entrepreneurial
organizations find
their niche and
systematically grow
their businesses through effective
marketing programs and persuasive
messaging and will be presenting
on social media at WHCA/
WiCALs 2015 Spring Conference.
She can be reached at amachina@
tornadomktg.com.
Clinical Corner
As ICD-10: Ready, Set, Code

Providers Expected to be Ready
October 1, 2015
By Lisa Eick
ne constant in the world of health

care is change. The dynamics of
the work we do, how we do the work,
and how we are paid for our work
is continually evolving and requires
flexibility as well as adaptability.
As you may recall, health care

organizations were gearing up
in late 2013 and early 2014 for
transitions to ICD-10 (International
Classification of Diseases) that were
to be implemented in October 2014.
In April 2014 that transition was
abruptly terminated. On July 31,
2014, CMS announced October 1,
2015 as the new date that all health
care providers, vendors, and payers
covered by HIPAA regulations
must begin using the new ICD-10
codes when providing or billing for
services.
Beginning October 1, 2015, the
ICD-10CM (diagnosis) codes will be
used for all health care settings with
the exception of inpatient hospitals
which will use the ICD-10PCS
(procedure) codes. Providers not
considered a HIPAA-covered entity

are not required to make the change
to ICD-10, but the ICD-9 coding
will become obsolete.
This is of importance for those
health care providers that work with
workmans compensation companies
as they will need to know if those
business entities are making the
change to ICD-10. The good news is
that CPT coding is not changing for
outpatient or physician services.
SO, WHAT IS THE REASON FOR THE
CHANGE FROM ICD-9 TO ICD-10?
ICD-9 was developed more than 30
years ago and is now considered to
be inadequate given the changes and
advances in health care and technology.
ICD-10 has been available and in use
by other countries since 1979, which
means that the United States cannot
compare U.S. morbidity diagnosis
data to international data.
The new code sets have updated
medical terminology, classification of
diseases and procedures. These changes
will allow for better data comparisons

in tracking health conditions, improve
clinical decision making, help to more
quickly identify fraud and abuse,
improve disease research, and help to
better design payment systems and
claims processing.
There are a number of differences
in the structure of ICD-9 and ICD10. The changes allow for more
specificity in diagnosis. Most clinical
documentation captures the specifics
of an injury or diagnosis, but the ICD9 codes are limited in scope.
The new codes will allow for improved
and more detailed code descriptions for
the purposes of diagnosis and will now
include descriptions of comorbidities,
manifestations, etiology or causative
factors, as well as anatomical location,
degree of functional limitation,
biologic and chemical agents, and
phase or stage of the disease to name
a few. ICD-10 also expands to include
laterality of affected body parts or
joint related involvement in a disease
process or injury.
The ICD-9 codes total approximately
14,000, and the new ICD-10 codes
total approximately 69,000 codes.
Ultimately, is it anticipated that
the expansion of the codes will
improve diagnosis, treatment, and
outcomes and form a more complete
picture of an individual across all
aspects of the health care system.
COMPARING ICD-9 AND ICD-10:
CHARACTERISTIC ICD-9 CM
ICD-10 CM
Code Length
3-7 characters
Composition
Space for
new codes
Details in
the code
Laterality
Sample code:
3-5 characters
Digit 1 =
alpha or numeric
Digit 2-3+ =
numeric
None
Digit 1 =
alpha
Digit 2 =
numeric
Digit 3 =
alpha or numeric
None
Many more specific

details (examples):
Comorbidities,
Manifestations, Etiology,
Complications, Detailed
anatomic location,
After effects of disease,
condition, injury, degree
of functional impairment,
Limited detail for many
Biologic and chemical
agents, Stage or phase
of disease, Lymph node
involvement, Lateralized
or localized involvement,
Procedure or implant
related, Age related,
Joint involvement.
None
81315 Open fracture of

head of radius
Identifies right versus

left in most cases.
S52122C Displace fracture of
head of left radius, initial
encounter for open
fracture type IIIA, IIIB, or IIIC
Many organizations had started

preparing for the transition to
ICD-10. For organizations that
have not begun preparing for this
change, the following list includes
action steps from CMS on how to
get started:
Establish a transition team and
project coordinator.
Develop a plan for the transition
to
include
timelines
for
task completion and assign
responsibilities.
Determine the effect ICD-10
will have on the organization;
for example what departments
currently use ICD-9 coding?
Work with software vendors that
are using ICD-9 to determine
transition plans for ICD-10.
This includes payers and billing
agencies.
Communicate the organizations
plans for transition to ICD-10 to
everyone involved.
Begin education and training early
in the process to ensure readiness
for the transition to ICD-10.
Lisa Eick, RN,

is an Education
and Compliance
Specialist with CE
Solutions. She can
be reached at lisae@
discovercesolutions.com.
Source: Adapted from CMS ICD-10 Implementation Guide, Comparing ICD-9 and ICD-10
https://implementicd10.noblis.org/understand_comparison/?guide, Accessed 3/19/2014.
Cover Story

Low Reimbursement, Competition,
Regulatory Climate Limit Workforce
By John J. Vander Meer
ong-term care professionals often

say that the most difficult job
in a skilled nursing or assisted living
facility is the role of a certified nursing
assistant (CNA) or other front-line
caregiver. Caring for frail elderly
and disabled residents is challenging
work that requires patience, a positive
attitude and frequently a strong back
and heart.
Many CNAs say working with their

residents is very rewarding; yet with a
median CNA wage of $12.39/hour in
Wisconsin, and many starting wages at
or below $10 per hour, those rewards
dont translate into competitive takehome pay for Wisconsins 65,690
front-line long-term caregivers.
However, according to recently

released data the State of Wisconsin
is currently ranked as thesecond-worst
Medicaid reimbursement system in the
country, and has been rated at similar
levels over the past 10 years, according
to analyses conducted by Eljay, LLC,
LTC providers are often unable to

provide wage rates that attract and
retain qualified CNAs, and other
frontline caregivers in positions
critical to maintaining quality care for
residents in the Badger States nearly
400 skilled nursing facilities and more
than 3,000 assisted living facilities.
So far, the process to develop the

2015-17 Biennial State Budget has
not offered providers much that
would help address this critical
challenge. Gov. Scott Walkers
proposed budget contains a 0 percent
increase in reimbursement for skilled
nursing facilities, and there are no
guarantees that the 3.2 and 2.5
percent increases in capitation rates
in the first and second years of the
biennium for Family Care MCOs
will mean any reimbursement
increase for assisted living providers.
CAREGIVER PAY
You have to have a competitive
pay structure, said Clint Maun, a
Median Hourly Wages in Wisconsin, 2013

$20.00
nationally recognized
expert
in
LTC
workforce issues. I
dont think you can
pay what everybody
else pays. If we want
to attract people
to this profession
you have to pay 65
percent of the median wage. Somehow
we need to pay CNAs a competitive
wage because werecertifyingthese
people. These are higher value jobs.
Providers like Bob

Mulder, an owner/
operator of Mulder
Health Care Facility,
a 93-bed skilled
nursing
facility
in West Salem,
expressed a sentiment
shared by many
facility administrators when he said
the nightly cost of many hotels rival
Wisconsins Medicaid reimbursement
rate to skilled nursing facilities,
despite the fact that we provide
24-hour care. The states Medicaid
reimbursement rate affects what were
able to pay front-line caregivers.
to provide care to its Medicaid

residents.
Medicaid recipients as of July 2012
(18,766 residents), including
Family Care enrollees, comprise
about 65 percent of all residents
served in nursing facilities.
The difference between the total
cost of the care that facilities
provided their Medicaid residents
and the Medicaid reimbursement
they received for providing that
care is nearly $330 million.
Mulder and many other LTC

administrators said that as the
economy has improved since the end
of the Great Recession, it has become
increasingly difficult to attract and
retain qualified CNAs, particularly as
they are able to locate employment in
other professions that pay more and
carry fewer barriers to employment.
Companies like Kwik Trip hire

starting employees at $2 more per
hour than were able to hire thats
certainly enough to make their heads
turn, said Mulder, who worries
about a wage war lurking on the
horizon as a result of inflation.
This issue is further complicated by the

fact that many prospective employees
have to go through an important, yet
costly training and certification before
even being able to work.
Jeremy
Kiley,
Regional Director
of Operations for
Dove Health Care,
which
operates
several facilities in the
Eau Claire/Chippewa
Falls area, said the
actual cost of the
classes that Dove offers is $625, and

costs $115 for state testing. The classes
involve 120 hours of coursework,
which usually takes up to 4 weeks
during which the candidate is not
getting paid. However, the state only
reimburses a fraction of those costs.
The state only reimburses CNA

training programs $200.55 of the
total cost, thats less than 1/3 of what
it costs to train and test a CNA,
Kiley said. That cost needs to be
adjusted so we can either lower the
cost of the class or provide the class
for free.
Kiley said the CNA training program

used to require 75 hours of training
like most other states in the country,
but the training requirement
was raised to 120 hours without
providing additional resources to pay
Continued on Pg. 20
$16.32
$15.00
$10.00
$12.39
$10.42
$5.00
$0.00
200% of the
Federal Poverty Line
Certified Nursing
Assistants
Source: Paraprofessional Healthcare Institute
All Occupations
According to a 2013-14cost and

reimbursement information on
Wisconsins skilled nursing facilities
(the most recent data available):
Wisconsin nursing facilities,
on average,lose$52.11 per day
for each Medicaid resident they
serve. For the average nursing
facility, that results in an annual
loss of more than $1 million
Stakeholder Spotlight
Co-Chairs of the Joint Finance

Committee Cut Through
State Budget Process
Co-Chairs of Powerful Joint Finance
Committee Address State Medical Budget
By Rep. John Nygren and Sen. Alberta Darling
overnor Walker outlined his

vision for Wisconsin during his
budget address this February. His
speech officially kicked off Budget
Season for us in Madison. For the
next few months, legislators from
both sides of the aisle will roll up their
sleeves and work on the state budget.
After his address, the governors
budget proposal was delivered to the
Legislature where it was immediately
introduced in the budget-writing
Joint Finance Committee (JFC). This
introduction formally moved the
governors plan to the Legislature so
lawmakers can analyze it and propose
modifications before we vote for
approval. It is now the Legislatures
turn to build upon the governors
solid starting point.
We are carefully
reviewing the
governors proposals,
but we need your help
In addition to ongoing priorities such
as growing our economy, developing
our workforce and transforming
education, Governor Walkers budget
includes many reforms to health care
in Wisconsin. Governor Walker is
proposing a statewide expansion of
Family Care, protections for seniors,
preservation of key safety nets like
Medicaid, and a biennial allocation

of approximately $30 million to
Disproportionate Share Hospital
Payments.
Currently, many of the governors
proposals fall under the jurisdiction
of the Department of Health Services
(DHS). Family Care is specifically
affected, as the proposal seeks to expand
the program to every county in the
state. Additionally, the proposal allows
DHS to add primary and acute health
care services to Family Cares benefits.
Managed care organizations (MCOs)
also see numerous changes under
the budget proposal, including
the expansion of MCO services
statewide. Moreover, the proposal
eliminates the requirement for MCOs

to obtain a permit from the Office
of the Commissioner of Insurance
(OCI), but specifies that if the Family
Care program operates statewide
then MCOs are insurers and may be
regulated as such by OCI.
As co-chairs of the Joint Finance
Committee, it is our job to protect
Wisconsin taxpayers. We are carefully
reviewing the governors proposals,
but we need your help. Please let
us know how we can improve the
governors budget plan. We welcome
calls, emails, letters, and hearing from
you in person. At the end of March,
we will be traveling to the four corners
of the state to hear Wisconsinites
opinions about the Governors budget
proposal. We hope you can attend
one of our hearings.
As with any proposed budget, the
Legislature will reshape and improve
the Governors proposed budget as it
goes through the legislative process.
Contrary to partisan rhetoric,
no Legislature has ever rubber
stamped a governors proposed
budget. Under our watch, JFC will
carefully scrutinize all of Governor
Walkers proposals, including those
regarding health care issues. After
our committee makes changes to
the governors proposed budget, the
Senate and Assembly may also make
further modifications to Wisconsins
2015-2017 State Budget.
Continued on Pg. 18
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Stakeholder Spotlight Continued

Ultimately, Governor Walker will
get the final say, as he can veto
portions of the budget. However,
we are confident that the work our
committee puts into the budget will
result in a document that is not only
the best for Wisconsin residents, but
is also one Governor Walker will be
able to proudly sign.
Rep. John Nygren
(R-Marinette)
and Sen. Alberta
Darling (R-River
Hills) are co-chairs
of the Wisconsin
Legislatures Joint
Finance Committee.
They can be reached
at Rep.Nygren@
legis.wi.gov and
Sen.Darling@legis.
wi.gov.
JOINT FINANCE COMMITTEE MEMBERS, 2015

ASSEMBLY
SENATE
Representative Nygren (Co-Chair) (R - Marinette) Senator Darling (Co-Chair) (R - River Hills)

Rep.Nygren@legis.wi.gov
Sen.Darling@legis.wi.gov
Representative Kooyenga (Vice-Chair)
Rep.Kooyenga@legis.wi.gov
Senator Olsen (Vice-Chair) (R - Ripon)

Sen.Olsen@legis.wi.gov
Representative Loudenbeck (R - Clinton)

Rep.Loudenbeck@legis.wi.gov
Senator Harsdorf (R - River Falls)

Sen.Harsdorf@legis.wi.gov
Representative Knudson (R - Hudson)

Rep.Knudson@legis.wi.gov
Senator Vukmir (R - Wauwatosa)

Sen.Vukmir@legis.wi.gov
Representative Schraa (R - Oshkosh)

Rep.Schraa@legis.wi.gov
Senator Tiffany (R Hazelhurst)

Sen.Tiffany@legis.wi.gov
AmericanWay
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Representative Czaja (R - Irma)

Rep.Czaja@legis.wi.gov
Senator Marklein (R - Spring Green)

Sen.Marklein@legis.wi.gov
Representative C. Taylor (D - Madison)

Rep.Taylor@legis.wi.gov
Senator L. Taylor (D - Milwaukee)

Sen.Taylor@legis.wi.gov
Phone: 608-566-1500
Representative Hintz (D - Oshkosh)

Rep.Hintz@legis.wi.gov
Senator Erpenbach (D - Middleton)

Sen.Erpenbach@legis.wi.gov
602 E. Albert St. Suite 1

Portage, WI 53901
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As a long term care provider you have a very

difficult mission. Your challenge is to provide
the best care possible to a population with
ever increasing medical and behavioral needs
in an extremely litigious atmosphere and
while under regulatory scrutiny second only
to that faced by the nuclear energy industry.
It is important that when you need a lawyer
to defend you against allegations of abuse or
neglect you turn to a team of professionals
who make it their mission to defend long
term care facilities who face legal challenges
throughout Wisconsin.
The team at Siesennop & Sullivan, led by
Attorney Pat Sullivan, has the experience you
need to best respond to the legal challenges
you may face as a long term care provider.
Siesennop & Sullivan has been successfully
representing SNFs, CBRFs and RCACs
in jury trials, mediations and arbitrations
throughout Wisconsin for the last 15 years.
We understand the unique challenges that
caring for frail, elderly residents can present,
as well as the complex state and federal
regulations that long term care providers are
required to meet.
You know that there are plaintiff s lawyers
who specialize in suing long term care
providers. You too should have a team of
lawyers who specialize in this area of the law
and who have been defending against such
claims for years.
Siesennop & Sullivan, Attorneys at Law

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Phone: 414-223-1731 | Fax: 414-223-1199
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Cover Story Continued

What are the reasons you have
vacant or open positions?
No applicants
42.1%
No qualified
applicants
61.7%
Competition with
other employers/
Non-competitive
wages and benefits
71.2%
Other
0%
19.6%
10%
20%
30%
40%
50%
60%
70%
80%
Source: 2015 Wisconsin Long-Term Care Provider Community Coalition Survey of 198 facilities.
for the costs of training, which has

increased the expense of training for
both providers and students.
The money isnt

great, but the process
is making it more
difficult to get the
training, said Mark
Scoles, administrator
of Greenway Manor,
a 60-bed skilled
nursing facility in
Spring Green, who has worked in the
field of long-term care for 40 years. I
can see why some could go to Culvers
and avoid the hassle.
CNA AVAILABILITY
Unfortunately for LTC facility
administrators not to mention
the people who need LTC services
the number of available frontline caregivers is going in the wrong
direction. According to numbers from
the Wisconsin Department of Health
Services, since 2012, the number of
new aides has decreased 18 percent,
and the number of CNA certification
renewals has gone down by 14 percent.
A recent survey of 198 LTC facilities

conducted by an alliance of Wisconsins
provider associations found:

1 in 9 CNA positions are unfilled;
Between
CNAs,
Licensed
Practical Nurses (LPNs), or
Registered Nurses (RNs) there
are 770 vacant FTE positions;
This translates into more than
30,000 work hours.
The reasons these jobs go unfilled
depends to a certain extent on the
region of the state, but across Wisconsin
there are several recurring themes.
La Crosse County currently has

an unemployment rate of under 4
percent. Add to that the fact that there
are two sizable hospitals and satellite
clinics all competing for the same
labor pool, its no wonder recruitment

and retention of CNAs is increasingly
difficult for LTC facilities. Mulder
said that with hospitals hiring more
CNAs, they are in a better financial
position to offer higher wages, signing
bonuses and tuition reimbursement
for CNAs to complete their RN and
LPN degrees and certifications.
In the last 5 years, it has increasingly

taken more effort to fill open positions.
Ten years ago, it wasnt as big of a
problem; 10 years ago skilled nursing
facility CNA wages and benefits were
considerably more competitive with
other job options that were available,
said Kiley, who has been working
in the LTC profession for 16 years.
Other industries/sectors have closed
the gap and people are choosing
other opportunities. We have several
companies in the area that draw our
CNAs out of the LTC sector for better
wages and benefits.
Barbara
Walters,
administrator
for
Rennes Health and
Rehab Center East,
a 129-bed skilled
nursing facility in
Peshtigo, has arrived
at a similar conclusion
in her efforts to secure
qualified CNAs in Marinette County
on the opposite side of the state.
WAGE INFORMATION FOR PERSONAL CARE AIDES, 2013

WAGE LEVEL
STATEWIDE HOURLY
STATEWIDE ANNUAL
Entry
$8.46
$17,590
Average
$10.32
$21.460
Experienced
$11.25
$23,400
NUMBER OF JOBS FOR PERSONAL CARE AIDES, WISCONSIN, 2013-2015
ESTIMATED EMPLOYMENT
AVE. # OPENING
PERCENT CHANGE
PER YEAR
2013
2015
38,897
41,474
6.63%
1,502
NUMBER OF JOBS FOR PERSONAL CARE AIDES, WISCONSIN, 2012-2022
ESTIMATED EMPLOYMENT
AVE. # OPENING
PERCENT CHANGE
PER YEAR
2012
2022
47,289
59,756
Source: worknet.wisconsin.gov
26.36%
1,585
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Continued on Pg. 24
LTC Legal Letter
Medical Record Requests:

Who Gets What and When?
Clear Processing Procedures Needed to
Limit Regulatory Exposure
By Brian Purtell and Esa M. Movroydis
equests for a residents medical

records can come from many
sources. The absence of a clear
procedure for processing requests can
cause regulatory or other exposure to
providers.
In 2010, Cignet Health served as
the cautionary tale for all covered
entities when it was fined a total of
$4.3 million for failing to comply
with HIPAAs medical-recordsdisclosure requirements. The Office
for Civil Rights (OCR) for the
U.S. Department of Health and
Human Services alleged that Cignet
had violated HIPAA by improperly
denying 41 patients access to their
medical records. OCR cited Cignet
$1.3 million for these violations, but
the failure to release records upon
request was not the organizations
only mistake: Cignets failure to
cooperate with OCR during the
investigation resulted in an additional
fine of $3 million.
Skilled nursing facilities (SNFs) and
assisted living facilities (ALs) can
learn some lessons from Cignets
mistakes. First, if you are the subject
of an OCR investigation for alleged
HIPAA violations, cooperate by
responding to OCRs demands timely
and appropriately. Second, and more
relevant on a regular basis, ensure that
you have the proper procedures in
place for responding to an individuals
medical-records request.
In developing internal procedures,

providers must assure compliance
with federal HIPAA laws (if a covered
entity), state laws, and providerspecific laws and regulations. In
doing so, providers should identify:
(1) how requests are made and how
they are internally processed and
recorded; (2) who is entitled to a
record; (3) what records are covered;
(4) the timing for responses to
assure compliance; and (5) the costs
associated with reproduction.
The providers procedure must
explain clearly how requests should be
processed to assure both that timely
responses are given and that record
releases are provided consistent with
applicable law. While all staff does
not need to know every aspect of the
process, they should, at a minimum,
be able to direct requestors to the
individual in charge of responding to
medical-records requests.
Internal procedures must spell out
who is entitled to records. This
determination is provider-specific and
involves an interrelation of state and
federal laws and regulations. Clearly,
individuals requesting copies of their
own records have the broadest rights
of access, however, there still are some
limitations to disclosure. Requests
from legally recognized agents, e.g.
guardians and health care agents
appointed under a Power of Attorney
for Health Care, generally stand in the
shoes of the resident for access-rights
purposes when the resident no longer

can exercise such rights.
The procedures also should define
what constitutes a record. Again, this
involves the interrelation of several
sources. HIPAA requires providers
to identify a designated record
set which guides what constitutes
a record. Under Wisconsin law,
provider-specific regulations describe
what must be contained in a medical
record, which again will frame the
basis for what information must be
disclosed. Clearly articulating what
constitutes an individuals record
will provide consistency in the types
of records disclosed. Just because a
document carries a patients name
does not automatically make that
document part of a record that must
be disclosed upon request. Ancillary
materials, including utilization
review or efforts for improving
the quality of health care, should
be maintained separately from the
individuals records.
Requests by family members or

others involved in care are more
complicated. A provider should not
release records to someone other than
the resident or legal representative
without the residents or legal
representatives authorization.
The rules for access differ depending
on whether the individual whose
records are involved still is alive.
Under Wisconsin law, a decedents
records may be released to a person
authorized by patient, which
includes the personal representative,
spouse, domestic partner or anyone
previously designated in writing. If no
spouse or domestic partner survives a
deceased patient, person authorized
by the patient also means an adult
member of the deceased patients
immediate family. HIPAA extends
access to persons involved in care.
Depending on the circumstances,
disclosures to spouses, parents,
children, domestic partners, other

relatives, or friends of the decedent
may be permissible, provided the
information disclosed is limited to
that which is relevant to the persons
involvement in the decedents care or
payment for care (unless doing so is
inconsistent with any prior expressed
preference of the deceased individual
that is known to the covered entity).
Procedures must specify a timeline
for responses, which may depend on
provider type. HIPAA generally requires
record request responses within thirty
days, although federal requirements
for skilled nursing facilities shorten the
response time to two days.
Providers are expected to provide
records in the form and format
requested, i.e. hard copy versus
electronic, if feasible for the provider.
Charges for reproduction should be
identified in advance and applied,
and they should be limited as set
forth by applicable law.
Penalties exist on both state and

federal levels for failure to provide
timely access to authorized record
requests. Providers are encouraged
to review their current policies
and processes to verify compliance
with applicable regulations and
laws and to assure that access rights
are respected while still protecting
against improper releases.
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.
Esa M. Movroydis
is
an
Attorney
with
DeWitt,
Ross, Stevens. She
can be reached at
emm@dewittross.com.
Providers are strongly advised to

require that all records requests be
submitted in writing. This written
request, at a minimum, should
detail the requestors identity; the
specific information sought, the
date of the request, the means
for determining whether there
is authority to release the
records, and the details
tracking any responses to
the request. Depending
on the nature of the
request, counsel or risk
management may need
to be consulted. To
ensure
compliance,
providers also should
have a process in
place for reviewing
requests received and
information provided.

We have been experiencing a shortage
in candidates for CNA positions for
the past 10 years, but it has gotten
worse in the last 2 years, said
Walters, who since 1974, has served
in virtually all of the critical positions
within a skilled nursing facility,
including starting out as a CNA
while attending college in Oshkosh.
I do believe that we are competing
with service industries for employees.
I have heard CNA candidates say
they can find less physically and
emotionally demanding work for the
same amount of money as we are able
to pay them. Being in a rural area
increases the problem as we dont have
as many candidates to choose from.
Maun said during the economic

downturn many low-skilled people
sought out positions in skilled nursing
or assisted living facilities as there are
always jobs available. However, as
the economy has improved, more
workers have been drawn away from
the profession just as the trickle of
aging Baby Boomers into facilities
swells into a flood.
According to employment projections

released by the U.S. Bureau of Labor
Statistics last year, between CNAs,
personal care and home health aides,
the United States will need more than
1.3 million new paid caregivers to
meet demand over the next decade.
In Wisconsin, projected demographic
shifts could magnify these challenges
even further.
A report published in Dec. 2013 that was

prepared for the Wisconsin Department
of Administration projected:
Wisconsins senior population
age 65 and over will increase
rapidly in every five-year
interval, from 777,500 in 2010
to 1,535,500 in 2040, nearly
doubling in 30 years.
The elderly population age 85
and over will rise steadily from
118,500 in 2010 to 145,500

in 2025, then nearly double to
283,500 in the following 15 years.
From 2010 to 2040, this age group
will increase by 140 percent.
In recent years, an increasing number

of trained CNAs have looked to the
position as a stepping stone rather
than a career choice. Some have
used their CNA training to move on
to work as LPNs and RNs, which
require training as a CNA before
moving onto those other roles.
The work of a CNA is physically

and
emotionally
challenging,
and many people feel they arent
financially compensated adequately
for the type of work they perform,
Walters said. We are in a very highly
regulated profession and as such, it
places additional stresses on CNAs.
REGULATION
One example of the excessive
regulation that LTC administrators
point to is a Federal rule promulgated
by the U.S. Department of Labor in
2011, which restricts the ability of
CNAs who are under 18-years-old
from using a patient lift without
being supervised by an adult.
This rule has an impact on the

number of minors we can employ on
a shift so that we can insure that we
have enough staff who are capable of
operating the lifts so that residents
dont have to wait to be transferred,
Walters said.
Kiley said Dove Healthcares policy

regarding the hiring of minors, who
at one time were a critical labor
source in LTC facilities, has evolved
with their growing CNA staffing
needs.
When the rule change came down,

we decided to not hire certified
nursing assistants under the age of
18. We have since changed our policy
at some of our facilities and now
have to monitor them to ensure that
they dont use patient lifts while on
duty. Patient lifts are extremely safe.
It is far more dangerous to let those
under the age of 18 transfer without
lifts. Its a strange rule.
Mulder said his facility simply

stopped hiring minors because of
the hassle. High school students are
not able to work for us anymore,
Mulder said. They can drive a car
why cant they use a patient lift?
Number of Vacant FTE in WI Nursing Facilities
THE GOVERNMENTS ROLE

Finding qualified workers is a
challenge in any field, but when
your ability as an employer to pay
prospective employees is strictly
limited by the value government
officials are willing to pay for
your service, it creates nearly
insurmountable barriers.
Dale Kelm, owner/

operator of Birch
Haven Senior Living,
which includes four
Community Based
Residential Facilities
ranging between 8and 17-beds located
in Ashland, said
he would be happy to extend any
reimbursement increase for assisted
living providers to his employees. Many
LTC facility operators say the same
thing.
I would have no problem if

reimbursement increases were tied
to staff wages and training, said
Kelm, who has worked in the LTC
profession since 1991. Im here to
provide a quality service I would
love to pay my staff more money.
Kelm points out that an increase in

wage rates for low-income CNAs
providing care in LTC facilities could
mean a commensurate decrease in

the cost of the public assistance those
individuals need.
When youre making a lower wage,
offering more money to do the
job could take people off public
assistance, Kelm said.
With the increasing level of patient
acuity that assisted living facilities
face in their residents particularly in
the form of residents with dementia
Kelm said he receives no increase
in reimbursement for dementia carecertified CNAs, which he would be
willing to pass on to his employees
who obtain higher certifications.
The state should step up, said

Maun, who pointed to the need
for greater reimbursement using
public policy tools such as a wage a
pass-through as a means of ensuring
rate increases go directly to frontline staff. I would probably have
the Legislature or regulatory groups
conduct in-depth summits of not
only the administrative personnel,
but also front-line CNAs so as to
encourage employee retention. I
would come up with an incentive
payment based on employment
retention levels.
Kelm said that for his part-time

employees, going over 30 hours a
Wisconsins Largest Occupational Groups

Direct-Care Workers
87,797
Retail Salespersons
76,180
Teachers from
Pre-K to 12th Grade
73,910
Metal Workers &

Plastic Workers
70,920
RNs and LPNs
63,330
60,040
Truck Drivers
0
20,000
40,000
60,000
1581
1600
1400
1200
800
600
400
200
0
Continued on Pg. 26
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.
1000
418
176
R.N.
L.P.N
C.N.A
Source: 2015 Wisconsin Long-Term Care Provider Community Coalition Survey of 198 facilities.
100,000
Source: Paraprofessional Healthcare Institute
FTE is defined as Full Time Equivalent-any position that is at least 40 hours per week.
A FTE is calculated as follows: number of hours each week for each position divided
by 40 hours (i.e. 60 hours per week divided by 40 hours=1.50 FTEs)
1800
80,000
MJ Care
Values
Respect n Integrity
Innovation n Service Excellence
Quality n Education
MJCare.com
EST D 1977
Professional Rehabilitation
& Health Services
Experience Matters
Jane Beisser, OTR, Vice President
2448 S. 102nd Street
Milwaukee, Wisconsin 53227
(414) 329-2429
Jane.Beisser@mjcare.com

week can be particularly concerning
because many of them attain health
benefits through BadgerCare, which has
income restrictions for those who can
receive benefits.
They are very aware of what their benefits

are and they are very concerned about
losing their health coverage, Kelm said.
On the other side, as a result of the

requirements and penalties for employers
included in the Affordable Care Act,
many employers are concerned about
the additional costs associated with
health benefits as well. While on the
one hand employers are required to pay
for employees who work more than 30
hours a week, they are not being a paid
reimbursement rates that enable those
employers to afford coverage for their
employees.
POLICY SOLUTIONS
As members of the Legislatures powerful
budget-writing committee consider
priorities within the 2015-17 Biennial
State Budget, Wisconsins provider
community ask that Legislators consider
the impact Medicaid reimbursement
has on the wagesfacilities can offer
front-line caregivers, not to mention the
millions of dollars that have been taken
from LTC providers over the years in
budget transfer schemes involving the
bed tax skim. With retiring caregivers
and increasing demand for LTC services
MANDATORY REPORTER DEMENTIA TRAINING ORIENTATION CNA SERIES NURSING COURSES

as a result of the aging Baby Boomer
population, providers say they want to
help offer solutions to these challenges,
but ultimately need state leaders to
address the shortfall of front-line LTC
caregivers.
Walters looks to greater reimbursement

of providers and prospective CNAs for
their training costs as one solution.
I think it would be easier to find

candidates if there was some type of grant
program to assist CNAs with the costs of
training, Walters said. Not only are the
initial fees high, but they need to take
time off of work for the classroom and
clinical training, which also contributes
a financial hardship for many of them.
Kiley sees opportunity in offering

greater flexibility for CNA training
requirements.
We need to find a way to eliminate

the up-front costs, and find a way
to provide paid training, Kiley said.
Willing participants simply cannot
afford the costs of the classes, testing,
not to mention not getting paid for an
entire month of training. We need more
reimbursement for training CNAs. We
need competitive wages and benefits. We
also need to look at revising the training
requirements. What about less classroom
training and more clinical experience on
the floor?
Wage Gap: LTC Workers Underpaid Comapared to Competition

Home Care
Hospital
Nursing Facility
$11.51
CNA
$13.53
$12.01
$32.17
RN
$33.94
$29.81
$0.00
$5.00
$10.00 $15.00
$20.00
$25.00
$30.00 $35.00
Source: Average salaries from the Bureau of Labor Statistics, May 2013
$40.00
On the Federal side, Mulder said he

looks to immigration reform as a means
of accessing a new labor pool. We need
more people in the labor force.
STAFFING = QUALITY
Ultimately, long-term care is labor
intensive, with personnel costs
comprising70 percent of the total
cost of providing care and treatment
to nursing facility residents. Moreover,
finding the right people to fill these
critically important positions is central
to providing quality care in Wisconsins
skilled nursing and assisted living
facilities.
Staffing is extremely important, when

youre short of staff, others have to pick
up the load, and then people get burned
out and quit, Scoles said. Then you
need more help. Lets not forget all the
paperwork in health care, my nurses help
when we are short of CNAs, but then
their charting might get behind.
Assembling the staff for a facility that

requires care for individuals 24 hours a
day, 7 days a week, and 365 days a year
can be extremely difficult.
Quality suffers if you dont have your full

staff available every day, Mulder said.
Kiley summed up Wisconsins CNA

shortage problem with this simple
truism
You simply have no care without

caregivers, he said.
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John J. Vander Meer
is the Director of
Communications
for the Wisconsin
Health Care
Association and the
Wisconsin Center
for Assisted Living.
He can be reached at
john@whcawical.org.
stephaniel@discovercesolutions.com
866-650-3400
855-345-6965
info@discovercesolutions.com
www.DiscoverCESolutions.com

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2015 MEMBER DIRECTORY ENCLOSED

Wisconsin Center for Assisted Living

131 W. Wilson Street, Suite #1001

A publication for Wisconsins Long-Term Care Profession by

YOU NEED BUSINESS

Madison | Milwaukee | Green Bay | Wausau | Eau Claire

The Caregiver Shortage

The Spring 2015 issue of Continuum is being released

OVER 25 YEARS SERVING SENIOR CARE FACILITIES

However, Wisconsins long-term care providers

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LTC LEGAL LETTER

PUBLISHED MARCH 2015

Spring 2015 | CONTINUUM 6

2015-16 Biennial Session

Cabinet Members Appointed, Legislative

he November elections last year

The states operating

In the 99-member State Assembly,

Following inauguration ceremonies,

Medical Supply Distribution

Getting more means:

Doing More For My Residents

Kim Adey (ext. 833) Dave Hosack (ext. 859)

Spring 2015 | CONTINUUM 8

Capitol Connection Continued

previous year and at $32.347 billion

Other initiatives Gov. Walker

Similar to his State of the State

Wisconsins GPR (general purpose

While not providing details, the

The Department of Administration

scope and ultimately more efficient,

The largest increase in GPR funding in

GPR over the biennium. The largest

accept the MCOs payment, service,

Again, the Governors budget includes

no requirement for an increase for

Serving Facilities in South Central WI

Spring 2015 | CONTINUUM 10

Using New Media to

Social Media Presents Marketing

ave you incorporated social

Social media requires adapting your