ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Sunday, April 28, 1996 TAG: 9604270014
SECTION: BUSINESS PAGE: 1 EDITION: METRO
SOURCE: SANDRA BROWN KELLY STAFF WRITER
TWO ROANOKE VALLEY HOMES that provide nursing care - one privately owned and the other the state's first attempt at privatization - look to stability at the helm to keep them off regulators' problem lists
On Feb. 12, Lisa Wilson became administrator at a Roanoke nursing home that for months had been in such disarray that state inspectors were shown incorrect records because the right ones couldn't be found.
That was partly because of turnover in administrators, she said.
Today, there are three manila folders on Wilson's desk that define her task for setting things straight. The folders - labeled Call Bell Assessment, Dining Satisfaction Survey and Quality of Care Survey - contain materials that should help prevent such problems happening again, she said. The folders contain the plan for getting and keeping a clean bill of health for Avante.
Avante at Roanoke is one of 66 Virginia facilities that have flunked the standard Medicare/Medicaid inspection since last July and one of two that the federal government slapped with a civil penalty. Last week, however, a government spokeswoman said the fine against Avante was in error.
Although new and tougher sanctions against noncompliant nursing homes have been established since last July, the government has imposed the penalties only on facilities that show a widespread pattern of deficiencies or have problems that could put patients in jeopardy, said Cindy Graunke, health insurance specialist at the Health Care Financing Administration, a unit of the federal Department of Health and Human Services.
Avante didn't fit that profile, so its penalty will be put on hold, she said, after being questioned about Avante's status.
Virginia's Office of Health Facilities regulations had recommended that Avante be forced to pay $238,500, the accumulation of $1,500 a day fines for the time Avante was not in compliance with federal regulations. The penalty will be reviewed along with 65 other penalties recommended against Virginia facilities when and if the moratorium on such penalties is lifted, said Graunke.
The other Virginia home dealt a penalty was a $390,000 fine against Forest Hill Convalescent Center in Richmond, which does have many deficiencies related to patient health. To date, 140 penalties have been imposed, but some are in the process of appeal, Graunke said. A facility can get a 35 percent discount by declining a hearing, and so far, the government has collected $570,000, but none from Virginia yet.
About 88 percent of the money collected went back to states' Medicaid funds specifically earmarked for protection of residents, she said. |n n| The sanction that is on hold is designed to stop inspection patterns like that of Avante at Roanoke.
The 120-patient facility, in Roanoke's Old Southwest neighborhood has a history of what the long-term health care industry calls "yo-yo compliance," which describes a facility's failure to pass inspection followed by foot-dragging on correction of problems. From July to September 1993, the home wasn't allowed to admit new patients because of deficiencies found during inspections. The facility failed inspections in October 1995 and failed again on Feb. 1, despite having said in December that it had addressed complaints and was in compliance.
In March, Health Care Financing threatened to withdraw payment for new admissions after April 5 and terminate the home's Medicare/Medicaid agreement if the place didn't address its shortcomings by last Friday.
The same shortcomings have shown up repeatedly in Avante's inspection reports - patients aren't bathed often enough, their call bells for help or attention aren't answered soon enough and patients don't get food trays when they should.
The problem involving incorrect records was related to lists of materials the home used for patients, rather than actual charges to their accounts, Wilson said. For example, patients who have lost bladder control often use more special absorbent briefs than Medicaid will pay for, so supplies used by the home's staff and supplies billed for reimbursement aren't the same.
In 1993, the state Health Department told Avante that its pattern of problems raised questions regarding the facility's ability to provide adequate care, or provide a safe environment, for patients.
Alan Litvack, who represents Avante Group in this region, has been working with Wilson to get the home on track. His hiring last year was part of a new direction for the privately owned Avante Group Inc., he said. Avante, based in Hollywood, Fla., has 16 facilities, four in Virginia, and others in North Carolina, Florida and Texas. Since 1990 the company has operated a number of homes that it used to lease to other operators.
Some of those facilities, like Avante at Roanoke, have required considerable investment to update their physical plants, Litvack said. About $1 million has been spent at Avante at Roanoke alone.
Staffing, as at every nursing home, has been a major problem for Avante.
But so has been keeping administrators. The home has had five or six administrators in the past two years. Several were transferred to the home from Avante facilities in other states and had to leave when they couldn't pass Virginia's exam for administrators
The company also has added incentives to stabilize staffing at its facilities, including bonuses for workers who have good attendance and staggered hours for their convenience. It also pays for its licensed practical nurses to go back to school to become registered nurses, he said.
Avante Group also recognized that it needed people who knew a community to run facilities in some areas, including Roanoke, Litvack said.
Wilson is a graduate of Radford University and had worked mostly managing retail stores until she went to work for a Rockbridge County nursing home in 1989.
She came to Avante as office manager, and even spent 90 days as its unlicensed acting administrator, which is allowed by state law, before she was tapped to be groomed as the administrator.
Wilson was an intern at Avante's Lynchburg facility where she accumulated the 1,080 hours of training required for her license.
Wilson is often at the job seven days week - "we're here until we feel we can go home" - and she also tries to be there some for the 11 p.m. to 7 a.m. shift.
And she's always working on her folder categories.
Under Call Bell Assessment, the goal is for patient bells to be answered within five minutes, she said. To find out how they are being answered, Wilson has staffers record the time a bell is heard and the time it is answered. Then she asks patients how the request for service was handled.
Her Dining Satisfaction Survey centers mainly on the timeliness of tray delivery to rooms. However, the kitchen now has a stove, which should help speed preparation that previously has been done with steamers and special skillets.
In the Quality of Care folder, Wilson is gathering suggestions about baths and bedtimes and general care from interviews with patients and family members.
"We really have changed," Wilson said last week.
LENGTH: Long : 124 lines ILLUSTRATION: PHOTO: Wayne Deel. In the new physical therapy lab at Avante ofby CNBRoanoke is the Administrator Lisa Wilson and Alan Litvack from the
corporate offices. color.