by Deb Bakerjian PhD, APRN, FAAN, FAANP

Greetings CALTCM Members and Friends!

It has been a while since I last wrote an article for The Wave, so I thought it would be timely to update the membership on the many activities that we have going on at CALTCM.

As most of you know, last year we announced an opportunity for nursing homes to participate in our “Best Practices” call.  We had 17 nursing homes submit proposals, all of which were fabulous!  Our panel of judges were really challenged to select the top five submissions, but after careful consideration and much debate back and forth, we selected five proposals that best met the criteria of the award.  I’m pleased to announce the five who were selected:

Partnership Health is the provider for the MediCal Managed Care program for 14 counties in Northern California.  As of last year, they had 532,000 lives enrolled. In my community in Sonoma County, we have found the Partnership to be innovative particularly with the care of high risk patients. In addition, they have reimbursed most providers better than the former fee for service MediCal system.

Late last year, I was pleased to hear that the Partnership is in the process of implementing a plan to pay some full time PA/LTC (Post-Acute/Long Term Care) providers 180% of usual rates.  I presume this is based on data suggesting more favorable outcomes at a lesser cost from these clinicians.  I have long thought this to be the case, but haven’t had supporting data.

Update & Opinion: 

CANHR v. Chapman (Epple, 1418.8) Case, What Should Nursing Homes Do?

California nursing homes, hospitals, and long-term care professionals waited a long time to get the final ruling in the matter of CANHR v. Chapman, which was decided last year.  The judge seemed to be taking longer than expected in issuing the writ, perhaps because he understood its far-reaching implications.  But finally, on February 4, the order was published—and as expected, it will not permit nursing home ethics committees or interdisciplinary teams (IDTs) to consent for antipsychotic drugs or for “withholding or withdrawing” of life-sustaining treatment.  The California Department of Public Health, via the Attorney General’s office, has 61 days from the date this order was released to appeal the decision, if they decide to do so.  CALTCM, along with the California Association of Health Facilities (CAHF) and the California Hospital Association (CHA), will be among the organizations urging CDPH to appeal this ruling, which as written will make it nearly impossible to provide appropriate, compassionate care to the unbefriended incapacitated nursing home resident.

My appointment to chair the Education Subcommittee coincided with my taking on the role of Director of Nursing Home Patient Safety for the Quality Improvement Organization (QIO) that covers our state.  Over the past 8 months I have had to opportunity to travel around the state, meeting with nursing home staff, other stakeholders and developing educational programs.  One of our key efforts is the reduction of antipsychotic medication use.  While we have made significant improvement in California, nearly 1 in 7 long stay residents are still on antipsychotics.  Continued improvement in this and other areas requires a true team approach.  Physicians, nurse practitioners and physician assistants can write orders, but staff must be fully engaged in creating an atmosphere that is conducive to successfully improving the care of residents.