NCCAP addresses H.R. 4248
(Taken from the NCCAP website)

January 11, 2008

NCCAP received numerous calls, emails r/t to the proposed H.R.4248, and NCCAP has submitted a statement to legislators as follows;

The National Certification Council for Activity Professionals (http://www.nccap.org/) has been certifying individuals that work with primarily the elderly populations in assisted living facilities, skilled nursing facilities and retirement facilities etc for over 20 years. We too are recognized by CMS in the federal regulations under F249 as being a nationally credentialing body for activity professionals which enable a person to be considered qualified to lead activity programming in these types of facilities.

NCCAP while not directly opposed to the intent of H.R.Bill 4248, are concerned with the exclusiveness of the terminology r/t who is qualified to lead the activity programs in especially the SNF facilities, as activities are reimbursable as long as the program is lead by the terms of F249, which as stated above includes NCCAP. If the bill is passed as stated, many administrators in the SNF's facilities could mistakenly believe that they must employ a recreation therapist to lead their programs which is not the case. If recreation is ordered by a physician, then it would indeed be conducted by a recreation therapist, much like if Physical Therapy was ordered by a physician it would be conducted by a physical therapist. Activity programs offered in geriatric facilities are therapeutic by nature in that they meet their meaningful quality of life in areas of mental, psychosocial, emotional, physical and spiritual well-being’s.

NCCAP much like NCTRC has over 6,000 national credentialed individuals (while NCTRC may have a larger number of certified, a good portion of their certified work in mental health or child development, not with the geriatric population). Both organizations are recognized nationally as being considered "qualified to lead activity programs," an NCCAP certified activity program is reimbursed by the daily per patient per day (ppd)rate, and does not require an additional physician order, yet meets the resident’s meaningful quality of life.

NCCAP would ask that you do NOT support the bill as worded, in that it is perceived exclusive in nature and could mistakenly be an assumed mandate that facilities discharge their qualified NCCAP certified activity professionals, only to replace them with a recreation therapist that probably has not been physician ordered.

NJAPA Legislative News
January 14, 2008, 2008
Kimberly Grandal, BA, CTRS, ACC
Legislative Chair

MDS 3.0 Update

The Centers for Medicare & Medicaid Services (CMS) announced that there will be an Open Door Forum (ODF) regarding the Minimum Data Set, Version 3.0 (MDS 3.0). This ODF is scheduled for the CMS auditorium in Baltimore, Maryland on January 24, 2008 from 1:00 pm to 3:00 pm EST and will report on the findings of a 5-year CMS Nursing Home MDS 3.0 Validation Study. CMS plans to implement MDS 3.0 changes nationally on October 1, 2009.

This session is currently full and closed to new registrants, however  an audio recording of this Special Forum will be posted to the Special ODF website at www.cms.hhs.gov/OpenDoorForums/05_ODF_SpecialODF.asp and will be accessible for downloading beginning January 30, 2008 and available for 30 days.
To download the MDS 3.0 Timeline, visit
www.cms.hhs.gov/NursingHomeQualityInits/Downloads/MDS30Timeline.pdf

For more information about the MDS 3.0 visit www.cms.hhs.gov/NursingHomeQualityInits/25_NHQIMDS30.asp

                   
NCCAP News

NCCAP is running a state association contest. The association and individual that assist the most people in obtaining their NCCAP certification will be awarded. The contest ends 12/31/07. NCCAP is also in the process of conducting research by reviewing the deficiencies specifically focusing on F248/249. This research is to determine if the individuals that received the deficiency held an activity credential or not.  The research will also indicate what types of citations are being written, to whom, how many etc. The results should be in by April 2008.

Related Resources

Brenda Scott, NAAP Vice President, and Standards of Practice Trustee, recently reported that the Alzheimer Association released the Dementia Care Practice Recommendation for End of Life Careon August 28th.  This is the third and final set of Dementia Care Practice Recommendations for Assisted Living Residences and Nursing Homes. The Recommendations focus on improving the end of life experience for people with Alzheimer’s and other dementias. You may download at http://www.alz.org/documents/DCPRPhase3_.pdf. Ms. Scott also reported that CMS offered a 4 part series of web-based presentations concerning Culture Change, entitled   From Institutional to Individual Care. They are archived for one year after being aired. The first of the series was aired on November 3, 2006, the second on May 4th, 2006, third on May 18, 2006 and the last one on September 14, 2007. To register, visit www.cms.internetstreaming.com.  Click on archived webcasts.

NCCAP News
January 14, 2008
Submitted by Debbie Hommel, ACC, CTRS

The following information was taken from the NCCAP web site. 

In November, 2007,  the NCCAP Board of Directors re-introduced ADC Track 5 indefinitely. Individuals that wish to apply for NCCAP Certification using ADC Track 5 need to complete the ADC Track 5 form, in addition to the NCCAP application, and follow the NCCAP standards accordingly.
To qualify for Track 5, the individual needs the following:

• Completion of a basic activity course, ranging from 36-90 hours, between the years 1991 and 2001
• 6 years experience (12,000 hours) within the past ten years.
• 30 hours of continuing education which includes 6 hours focusing on activity documentation.

NCCAP has also been working on evaluating ACC Track 3 and after completing a pilot program and much discussion – the Track 3 for becoming a certified consultant has been revised for an undesignated time frame.   Those that have an Associate’s Degree, 4000 hours of activity experience, 40 hours of continuing education, completion of the MEPAP course(s), 200 hours of consulting, and completion of the 2 year Activity Professional Manager & Consultant curriculum with a qualified mentor can apply. 
For more information about either of these topics, you can visit the NCCAP web site at www.nccap.org.  To obtain applications for national certification or to find out how you can become certified, you can visit the NCCAP web site or call 757) 552-0653.  Or you can call or email Debbie Hommel, NCCAP State Representative at debbiehommel@comcast.net or 609-698-9530.

NJAPA Salary Survey: Spring 2005
by Robert J. Smaldore, ACC

As we did three years ago (as well as in the year 2000), during this spring’s annual NJAPA convention The Long Range Planning Committee conducted a salary survey. We are again pleased to offer to our members the all-important “hard numbers” that resulted from the survey, and review, at the end of the figures, some important points to consider.

View Results

Fall 2002 -
Survey Findings

It has been noted that many nursing homes cite low staffing, especially on the weekends. This also applies to the Activity Department. Weekend activities have been a focus of family members and of course the residents themselves, stating that there are not enough activities on the weekends. Usually there is only one staff person to provide activities for the entire resident population. Activity Directors struggle with this ever enduring problem.

In a recent survey finding...
COMMENTS: Not enough activity being offered to meet the residents' needs. Supplies not being utilized by the staff (other than activity staff). Complaints by family and residents. Individual resident's assessments, no team effort to meet low-functioning residents' needs. The need for in-servicing all staff on how to implement activities for one to one. Interventions to reduce anxiety and stress of the low-functioning resident. - These are only a few examples of the citations that were received.

In conclusion, be aware of what a surveyor will now be focusing on - Weekend Activities.

Sharon (Walters) Kelly, Legislation Chair

September 2002 - The Elder Justice Act of 2002

(Summary Distributed by the Senate Special Committee on Aging)

Although the number of older Americans is fast growing, the problem of elder abuse, neglect and exploitation has long been invisible and presents among the gravest issues facing millions of American families. The Elder Justice Act of 2002 would provide federal resources to support State and community efforts on the front lines dedicated to fighting elder abuse with scarce resources and fragmented systems. From a social perspective, elder justice means assuring adequate public-private infrastructure and resources to prevent, detect, treat, understand, intervene in and, where appropriate, prosecute elder abuse, neglect and exploitation. From an individual perspective, elder justice is the right of every older person to be free of abuse, neglect and exploitation. The Elder Justice Act would promote both aspects of elder justice with the following provisions:

• Elevate elder justice issues to a national attention. Creation of (1) Offices of Elder Justice at the Departments of Health and Human Services and Justice to serve programmatic, grant-making, policy and technical assistance functions relating to elder justice, (2) a public-private and a Coordinating Council to coordinate activities of all relevant federal agencies, States, communities and private and not-for-profit entities, and (3) a consistent funding stream and national coordination for Adult Protective Services (APS).

• Improving the quality, quantity and accessibility of information. An Elder Justice Resource Center and Library will provide information for consumers, advocates, researchers, policy makers, providers, clinicians, regulators and law enforcement and prevent “reinventing” the wheel. A national data repository also will be developed to increase the knowledge base and collect data about elder abuse, neglect and exploitation.

• Increasing knowledge and supporting promising projects. Given the paucity of research, Centers of Excellence will enhance research, clinical practice, training and dissemination of information relating to elder justice. Priorities include a national incidence and prevalence study, jump-starting intervention research, developing community strategies to make elders safer, and enhancing multidisciplinary efforts.

• Developing forensic capacity. There is scant data to assist in the detection of elder abuse, neglect and exploitation. Creating new forensic expertise (similar to that in child abuse) will promote detection and increase expertise. New programs will train health professionals in both forensic pathology and geriatrics.

• Victim assistance, “safe havens,” and support for at-risk elders. Elder victims’ needs, which are rarely addressed, will be better met by supporting creation of “safe havens” for seniors who are not safe where they live and development of programs focusing on the special needs of at-risk elders and older victims.

• Increasing prosecution. Technical, investigative, coordination, and victim assistance resources will be provided to law enforcement to support elder justice cases. Preventive efforts will be enhanced by supporting community policing efforts to protect at-risk elders.

• Training. Training to combat elder abuse, neglect and exploitation is supported both within individual disciplines and in multidisciplinary (such as public health-social service-law enforcement) settings.

• Special programs to support underserved populations including rural, minority and Indian seniors.

• Model State Laws and Practices. A study will review state practices and laws relating to elder justice.

• Increasing Security, Collaboration, and Consumer Information in Long-Term Care.

• Improving prompt reporting of crimes in long-term care settings

• Criminal background checks for long-term care workers

• Enhancing long-term care staffing

• Information about long-term care for consumers through a Long-Term Care Consumer Clearinghouse

• Promoting accountability through a new federal law to prosecute abuse and neglect in nursing homes

• Evaluations and accountability. Provisions to determine “what works” and assure funds are properly spent.

August 1, 2002 -
Nursing Home Staffing Accountability Act 2002

The Senate is calling upon all nursing homes for Medicare and Medicaid services to improve the quality of the data they offer on nursing homes' staffing.

As we are aware, this is an imposing issue in all nursing homes. The lack of sufficient staffing impedes on the direct care of the residents' daily welfare. Senator Charles Grassley (R-IA), John Breaux (D-LA), and John Rockefeller (D-WV) introduced August 1, 2002, (S.2879) the Nursing Home Accountability Act 2002 in response to research indicating that information on staffing levels in nursing homes is often incomplete, inaccurate, and outdated. The bill will also indicate that all nursing homes will post daily staffing levels beginning January 1, 2003. This information will be accessible to the public, who may be looking for placement of their family member.

The Administration on Aging announced the US Department of Health and Human Services will launch Alzheimer's demonstration projects in eight states and renew funding for 25 others. HHS assistant secretary for aging, Josefina G. Carbonell, made this announcement on July 15, 2002 in honor of the 10th anniversary of the Alzheimer's Disease Demonstration Program.

The GAO, a watchdog agency for the federal government indicated that nursing staffing hours are measured by the number of nursing hours provided per resident per day. This clearly has an effect on daily care. The senate recently approved an amendment that would send states some much needed Medicaid relief. The Department of Health and Human Services will not publish the final H1PAA security ruling in August as promised in May, 2002, Federal Register.

Note the rule was just released and will be published in the Federal Register on its final revisions next month.

July 2002
National Citizens' Coalition for Nursing Home Reform
Applauds Defeat of McConnell Amendment. Amendment Would have Provided Immunity for Abuse and Neglect Of Nursing Home Residents

WASHINGTON -- The nation's 1.6 million nursing home residents came dangerously close today to losing the ability to enforce their rights, said Donna Lenhoff, executive director of the National Citizens' Coalition for Nursing Home Reform.

The Health Care Liability Reform amendment, introduced Friday by Sen. Mitch McConnell (R-KY), would have "erected a new barrier to the enforcement of nursing home residents' rights and allowed the suffering of residents to go unpunished," Lenhoff said.

The measure, which was offered as an amendment to the prescription drug bill, included provisions that would have severely restricted punitive damages in nursing home cases, limited residents' attorneys' fees, and imposed an insufficient statute of limitations.

" Limiting punitive damages in cases of nursing home abuse and neglect betrays some of our nation's most vulnerable and defenseless citizens," Lenhoff said. "Recently released federal reports confirm that a shocking number of frail elderly and disabled nursing home residents suffer from abuse and neglect. The McConnell Amendment would have given nursing homes virtual immunity for the abuse and neglect of residents entrusted to their care."

The amendment's Statute of Limitations provision would also have failed to provide adequate time for residents and their families to bring cases, Lenhoff said.

" It often takes time to discover a nursing home resident has suffered abuse. Elderly residents whose memory or ability to communicate is impaired may not be able to communicate what has happened," Lenhoff said. "A 2-year-period would keep many nursing home cases from ever being brought by the victims of abuse."

Senator Edward Kennedy (D-MA) led the charge against the amendment, which was defeated by a vote of 57 to 42.

Spring 2002 -
NJAPA Salary Survey

As we did two years ago, during this Spring's Annual NJAPA Convention, The Long Range Planning Committee conducted a salary survey. We are pleased to offer to our membership, the all-important "hard numbers" that resulted from the survey, and review, at the end of the figures, some important points to consider.

Average Director's Salary (based on 61 responses)
Statewide Average Department Director's Salary: $35,463.00 ($17.04 per hr.)

Average Director's Salary by Region:
• North: .. $36,702.00 ($17.64 per hr.)
• Central: $36,460.00 ($17.52 per hr.)
• South: .. $33,228.00 ($15.97 per hr.)

High Salaries:
• $50,000 Monmouth County
.............. 18 Years Experience, ADC
.............. 120-150 Bed facility
.............. Staff of 15

Low Salaries:
• $21,000 Central New Jersey
.............. no cert. noted
.............. 1-60 Medical Day Care
.............. Staff of 3

• $50,000 Middlesex County
.............. 15 Years Experience, CTRS
.............. 240-100 Bed facility
.............. Staff of 12

• $20,000 Cumberland County
.............. 30 Years Experience, ADC
.............. Adult Day Care
.............. Staff of 2

Average Assistant Director's Salary
(based on 35 responses)
Statewide Average Salary: $26,800.00 ($12.88 per hr.)

Average Assistant Director's Salary by Region:
• North: .. $32,187.50 ($15.47 per hr.)
• Central: $24,048.00 ($11.56 per hr.)
• South: .. $25,817.25 ($12.41 per hr.)

High Salaries:
• $40,000 Burlington County
.............. ADPC
.............. 241-300 bed facility
.............. Staff of 30

Low Salaries:
• $18,200 Salem County
.............. no cert. noted
.............. 61-120 bed LTC facility
.............. Staff of 6

• $39,500 Passaic County
.............. ADC
.............. 300+ bed facility
.............. Staff of 21

• $18,720 Camden County
.............. no cert. noted
.............. 240 bed LTC facility
.............. Staff of 18

Average Activity Assistant's Salary
(based on 71 responses)
Statewide Average Salary: $21,220.04 ($10.20 per hr.)

Average Activity Assistant's Salary by Region:
• North: .. $21,778.40 ($10.47 per hr.)
• Central: $22,382.22 ($10.76 per hr.)
• South: ..$18,905.52 ($9.08 per hr.)

High Salaries:
• $36,000 Central New Jersey
.............. 12 Years Experience
.............. 240-300 bed facility
............

Low Salaries:
• $14,560 South Jersey
.............. 1+ Year Experience
.............. 1-60 bed LTC facility
.............. ($7.00 per hour-1 response)

• $32,000 Central New Jersey
.............. ADC
.............. 240+ bed State Facility
.............. Staff of 10

• $13,520 Cumberland County
.............. ? Years Experience
.............. 120-180 bed LTC facility
.............. ($6.25 per hour-1 response)

In reviewing the above figures, here are some points you might want to keep in mind. In the survey conducted at the Spring 2000 Convention, there were only a total of 76 responses in all three job categories. This year there were 167 responses, and the highest number of responses came from those who identified their position as Activity Assistant. By State Region, the gaps in salaries seems to be narrowing, especially between North and Central, NJ. Also, the vast majority of respondents, in all three positions, were working in LTC settings. Finally, I know from firsthand experience recently helping two NJAPA members, that utilizing this Salary Survey has, and can, result in a higher salary than expected. Good Luck to All!

Bob Smaldore, ACC, Long Range Planning Chair

September 2001 -
Centers for Medicare and Medicaid (CMS)
along with the American Institute for Research(AIR) proposed revisions to the State Operations Manual (SOM).

The intent, is to develop increased guidance for identifying specific levels of "Scope and Severity" related to deficiency findings.
Proposed changes would affect new definitions for "Scope", as well as the interpretive guidelines for seven different tags.

Those tags are:

• F248, F249 Activities
• F314 Pressure Sores
• F315 Urinary incontinence
• F325 Nutrition
• F371 Sanitary Conditions

Currently, CMS and AIR, have not reconvened to hear public comment to assist the committee in finalizing the new guideline release. There is no current information when this will be released. Other options are being explored. Current levels are:

....•Level 1 - no actual harm, with potential for minimal harm
....•Level 2 - no actual harm,with potential for more than minimal harm that is not ....
.... immediate jeopardy
....•Level 3- actual harm that is not immediate jeopardy
....•Level 4 - immediate jeopardy to residents' health and safety

The guidance on Scope levels-there are three levels:

....• Isolated ............• Pattern............• Widespread

Ask your nursing department in your building for all the current definitions related to Scope and Severity for clarification in the manual for survey procedures for LTC facilities.