I have a question for other Iowa long term care social workers. I am curious if there is anyone that has an eye doctor that comes to their facility to make visits aside from Aria/Senior Vision Services.
Erin Folkmann, BSW
Amana Retirement Community
Over the past couple of years lost hearing aids, glasses and cell phones have become an increasing issue. We have a memory unit and numerous residents in various stages of dementia. Much like many other care centers I would assume. We have families that want their loved ones to have these items, which I understand. The issue is that we have residents that throw cell phone, glasses and hearing aids away, hide them or place them in a pocket that goes to the laundry. Once they are lost or destroyed, of course social services is contacted to call the family. Often families want the care center to pay to replace these items.
My question is… how do other care centers handle this? It gets very costly to replace these Items. Do other care centers replace the items or do they have some type of agreement or document that family sign that states that the care center is not responsible for lost items.
I would appreciate any guidance that you could provide. Thanks.
~ Tracy Gott, LBSW, Methodist Manor, Storm Lake
That is a problem that all care centers have. An option is for the staff to keep the glasses/hearing aides, etc. in the medication cart at night, and then given to the resident in the morning. Our policy is that we do not replace cell phones and that is shared with families upon admission. Our policy is to do a facility wide search for glasses, hearing aides, etc and then to inform the families. If a resident in on Medicaid, you may be able to get glasses reordered, but I think it is only once a year. I’m not sure about that.
~ Lori Miller, LBSW. Bishop Drumm, Johnston
I would like to inquire of any companies that provide dental services in nursing facilities in Iowa.
I am aware of Senior Dental Care. Does anyone utilize Senior Dental Care? How is that working for your facility?
Are there other Dental Companies?
Thank you. Cindy Epperly, LBSW, Washington County Hospital & Clinics
We have utilized Senior Dental for 2-3 years in our facility. It works great getting our residents seen in house.
Rebecca Peterson, Good Samaritan, Red Oak
Prior to my retirement from Westhaven Community, we worked with Senior Dental Care. It was wonderful for those who were Medicaid participants and I believe they could provide services for private pay for full payment. They brought in everything they needed. They billed Medicaid and Medicaid continued to pay us the same they did prior to the dental set up. We set them up in the beautician's room one day or so per month. I hope that helps.
Connie Hadden, Retired, Ames
I work at a SNF in Council Bluffs, IA, and we use a dentist through Align Care LLC. Here is a link to their website - http://www.align.pro/. The dentist visits the facility about every 2 months (or more often if necessary) and does all-day clinics with his patients. We also used them when I worked at a SNF in Omaha, NE, so I know they cross state lines.
Kelsey Jochum, Midlands Living Center, Council Bluffs
We utilize Senior Dental at our facility and it has been working out very well. They come about every 3 months to do teeth cleanings, denture checks, etc. They also accept Medicaid. This is our main point of contact for scheduling visits, etc:
Amanda Godfrey RDH/Clinical Manager Iowa Central
Senior Dental Care
Janet Sofen, LMSW, Trinity Center at Luther Park, Des Moines
We just started working with Senior Dental Care. So far it seems to be going well!
Amanda Jamarillo Ayon, Calvin Community, Des Moines
We use Senior Dental and have had a good experience.
Lori Miller, Bishop Drumm, Johnston
We use them and they have been wonderful. They come in on their regular schedule and will come in as needed as well. We always get progress notes the same day from them and they are great about touching base with the nurses on any issues.
We, at Algona Manor Care Center have just started using Senior Dental. We have had a few bumps in the road as far as families are concerned, but haven’t had any issues thus far! Thank you
Jolene Hagedorn, Algona Manor Care
Our facility recently started using Senior Dental Care for our residents. So far it is going fairly smoothly, and is especially great and meeting the demands of those residents on Medicaid – since we were having a hard time finding local providers that would accept Medicaid. There were a few logistical ‘kinks’ to work out in the beginning but overall we are happy with them.
Nicole Larsen, Social Services & Admissions, Grand JiVante, Ackley
We are looking to update our policy to be more in line
with recent memo from the long term care ombudsman. Does anyone have policies they could share?
~ Marcia Pitt, Longview Home, Missouri Valley
Tonya Amos, LTCSWI Board Member and Local LTC Ombudsman, provided samples from the Office of the State Long Term Ombudsman
Sample Sexual Expression Policy for Facilities: Sexual Exp Facility Policy Sample (3).pdf
Sample Sexual Expression Policy for Residents: Sexual Exp Policy for residents Sample (3).pdf
I was wondering if anyone has found psychiatrists that will come to your building or do telehealth. We have a mental health nurse practitioner that makes rounds but PASRR requires a psychiatrist and report a nurse practitioner is not sufficient. Please let me know. I have tried several telehealth services but they all have nurse practitioners.
Marcia Pitt, LMSW, Longview Home, Missouri Valley
We also have a psychiatric nurse practitioner, who seldom leaves any information on her thoughts or ideas regarding our residents. It doesn't help us with our behavior issues. Good luck! ~ Nancy Wentzel, PACH, Emmetsburg
We just met with encountertelehealth representative. They do NOT offer a psychiatrist and use geriatric psych nurse practitioners. They are able to prescribe meds and write up behavioral plans and provide staff inservices. Their goal is to reduce antipsychotic rates. They will provide the equipment for the telemedicine. They charge $200-300. They cannot bill Medicare, but can bill Medicaid. We are going to sign up for this service. Can take up to 30 days, depending on if the info/consents have been gotten. Psychiatrists are hard to get into, sometimes up to 3 months. We are in a troubling era in regards to psychiatrists. ~ Lori Miller, Bishop Drumm, Johnston
Note: I received an email from Jen Amis, President of Encounter Telehealth, who provided some updates for their organization.
We have had the University of Iowa Hospitals and Clinics contact us re: Telepsychiatry. I am not sure of the area they would cover as our campus is only about 30 miles from them, but the contact for this is Susan Duffy, MD at 319-384-9248 or email email@example.com. ~ Karen Roe, Highland Ridge, Williamsburg
I am attaching the contact information for Doug Wilson (Integrated Health Partners, 855-270-3625). The agency he works for provides telepsychiatry in Iowa and I have heard that providers and clients have had good experiences with this service. I do not know if they provide services in other states. ~ Sylvia Mork, Prairie View Management, Fayette
I asked our director about the question from Marcia Wells and getting the PASARR eval done. Here was his answer. I have clarified the role of the providers at our office he references. And Dr. Bigelow has his psychologist doctorate. I don’t think only psychiatrists can do level 11 PASRR evaluations. Mark, Dianna (both are ARNP BC psychiatric prescribers at our office), Nancy (LISW at our office) and I can do them because we are specialists. Of course, only I can do the IQ testing to determine ID. However, I know that many providers do not like to do them so there is likely a shortage of those that will come to NF to complete. I would search for telemedicine providers and see which ones provide PASRR evaluations. Here is a link I found that might be helpful. http://www.pasrrassist.org/resources/federal-regulations/pasrr-plain-english " I hope this is helpful to you or any of our members
~ Elizabeth Anderson, SWIMHC, Atlantic
We are looking for any policies any other facilities have on scooter (or motorized chair) use within the facility—if you allow, do not allow or have restrictions on when and if they can be used. We recently had a couple families that went out and bought scooters for their loved ones and the resident is not safe or does not understand how to drive them and both are upset that we are restricting the use (until therapy clears them for safety). Any and all policies would be appreciated. Thanks so much!
Lyn Ahrenholtz, LBSW, Elm Crest Retirement Community
We do not allow scooters in our nursing facility. We do allow them in our independent living and assisted living but they have to go to “scooter school” with our therapy department to make sure they are safe to drive the scooter. ~Sue Milligan, LBSW Friendship Village, Waterloo
We only allow electric scooters, ‘following’ an OT evaluation for driving safety, but don’t have an official policy stating that. Then you also need to look at the room situation, if it can accommodate a scooter in the room, as we don’t allow our scooters to be parked out in the hallway. It could be made into a 2 sentence policy. Doesn’t have to be a long, detailed policy. Then I would recommend having it in your admission packet, and post the policy within your facility or in the newsletter or sent with their monthly billing statement. ~ Lori Miller, Bishop Drumm, Johnston
I have a question about Medicaid State to State. I have had requests in which the adult children live in Iowa, and their parents live out of state (in Massachusetts) and on Medicaid. I didn’t have any information to provide to the family so I emailed Scott Hartsook, but haven’t heard back from him. I know this isn’t actually his area of expertise, but thought he might be able to direct me to the people who might know. I am unsure as to how this works, who pays, etc. Is it transferred to Iowa, and if so, what’s the procedure to follow? Anyone work with this?
Patti Abram, The Village, Indianola
I believe that they would have to file for Medicaid again once they reside in Iowa. You have to be an Iowa resident before applying. If you can’t get answers from DHS, I would suggest that the family call the Legal Hotline for Older Iowans toll free intake number. It is 800-992-8161. Tonya Amos, Iowa Dept. on Aging, Des Moines
Interesting situation. I would suggest that they contact the Massachusetts’ DHS office first. Then contact Iowa DHS office, 855-889-7985. www.dhsservices.iowa.gov for faster IA application. Lori Miller, Bishop Drumm, Johnston
I am struggling to find an answer to a question and I would like to know what other social workers are doing in regards to a significant change on the MDS and the PASRR. Ascend says that a new PASRR is required every time a significant change occurs regardless of cause, i,e, physical decline or improvement. Barb Brown, RN, at Medicaid says “no, only when the change is related to mental health.” She suggested I call IME. I did and they gave me a contact person but did not hear back. What are others doing? Any suggestions?
Marcia Pitt, Longview Home, Missouri Valley
I practice by updating the PASRR only when changes in mental health. Jill Lemke, Mercy Living Center North, Clinton
I am not doing it with condition changes. If I had a resident who already has a Level II, then I would probably do one, but not for a Level I resident. But I don’t have any Level II residents in my facility. Lori Miller, Bishop Drumm, Johnston
It was my understanding that the change in condition related to mental health, also. I will see if I can find some info from the PASRR workshop that I went to a few weeks ago that will back up my understanding. Patti Abram, The Village, Indianola
I thought that a new PASRR is only required when there is a significant change for those persons where a Level 2 is required, not for everyone. I am not sure about whether there is a distinction between mental or physical changes. I would be interested in what you find out from IME. Thanks. Kathy Soetmelk, Salem Lutheran Homes, Elk Horn
I did speak with an Ascend representative this Spring regarding the “Sig Change” issue and they clarified it stating that if someone had a severe psychotic break that would trigger a decline or an improvement along the lines of no longer needing LTC. Obviously, as a group, clear feedback is needed on this topic. Maybe one of our trainings could include this topic? Denise Carle, Bethany Lutheran Home, Council Bluffs
Have gotten conflicting information as to whether assisted living is considered “returning to the community”, or not. Anybody know the answer? Are they not also considered “institutional”, as NF’s are? Thanks for your help. Bill at Briarwood
· Assisted living is considered “returning to the community”. ~ Elaine Malek, LBSW, Pella Regional Health Center
· I’ve heard both. I’ve heard it justified that because it is a lower level of care it could be considered “returning to community/home with assistance” or of course if an option of ALF is available it would then be considered a “facility” and not necessarily the ‘community’. It’s about as clear as mud. Hopefully someone has a better answer. ~ Nicole L. Larsen, CDP, Heritage Care Center, Iowa Falls
· I believe it is considered returning to the community, as least that is how I term it. ~ Diane Zills, Social Worker, Southfield Wellness Community, Webster City
· No, returning to Assisted Living is considered returning to the community. It is in the RAI manual. ~ Mary Toel, Good Samaritan Society, Le Mars
· It is my impression that if they are discharging from your NF building, it would be considering returning to the community. I don’t think they are considered an institution. Although they do have some regulations from DIA, they are quite relaxed regulations. ~ Lori Miller, Bishop Drumm, Johnston
· I don't know the context you are asking about specifically but if it is MDS related this is what the RAI says:
Coding Instructions for Q0300A, Resident’s Overall Goals Established during Assessment Process
Record the resident’s expectations as expressed by her or him. It is important to document their expectations.
Code 1, Expects to be discharged to the community: if the resident indicates an expectation to return home, to assisted living, or to another community setting.
Code 2, Expects to remain in this facility: if the resident is in the nursing home for rehabilitation or skilled nursing care and indicates that after this care is complete, he or she expects to remain in the nursing home.
Code 3, Expects to be discharged to another facility/institution: if the resident expects to be discharged to another nursing home, rehabilitation facility, or another institution.
Code 9, Unknown or uncertain: if the resident is uncertain or if the resident is not able to participate in the discussion or indicate a goal, and family, significant other, or guardian or legally authorized representative do not exist or are not available to participate in the discussion.
Hope this helps! ~ Kristi Barnett, BSW, Grundy County Memorial Hospital, Grundy Center
· In reference to MDS section Q assisted livings are considered as discharge to the community. (Coding instructions for Q0300A were also included as in the response above) ~ Josie Reinhardt, Manor Care, Waterloo
Would those members who have Dementia care areas be willing to submit their criteria for discharge from that area. I know some CCDI’s are ambulatory units only and others have other requirements—we are trying to rewrite the criteria we currently use and I am hoping to find suggestions from others about what is working. Thanks so much. ~ Lyn Ahrenholtz, LBSW, Elm Crest Retirement Community
Submit responses to: firstname.lastname@example.org
Does your facility allow pets in your care center? We are thinking of trying this but have no experience or information. Submitted by: Leisa Osterhaus, LBSW, Shady Rest Care Center
One of our members is trying to locate a therapist who would provide counseling services to residents in a facility. She is wondering if any of you might be aware of some source….of an agency that has a therapist who goes to a facility….or, if there is some other resource that might be worth contacting. Her facility is in central Iowa (Indianola).
· We use Deer Oaks and have found great success. A LISW visits Residents on an individual basis at least 2 times weekly. The counselor lives locally and is accessible to the facility. The toll free number for contact is: 888-365-6271. (www.deeroaks.com) )
· I am not sure how far she will travel, but we have used Dr. Karen Ahrens out of the Central Iowa Psychological Services (515-222-1999). She has always been very good with our residents. It sometimes takes about a month to get her to come in, but she does a great job and I have had a lot of positive feedback from the residents on her.
· She might check with an area hospital or one from Des Moines to see if they can provide outpatient therapy sessions in her facility. Another resource could be U of Iowa hospital and clinics. We have an outreach program that provides a psych nurse to come once a month for our residents that need help.
· I go through Deer Oaks
· You could check with Ascend. (Ascendami.com) - they have the contract in IA for the PASRR Level II evals that independent contractors (masters or Ph.D. level professionals) perform in nursing facilities. Maybe some of the contractors have private practices and would be willing to provide counseling.
· Dr Karen Ahrens with Central Iowa Psychological Services
· Deer Oaks, 210-615-3455, fax 888-34307632. Corporate Office: 7272 Wurzbach Rd, Ste 601, San Antonio, TX 68240. They hire local therapist. We have been happy with their services.
· We just signed a contract with a group called Deer Oaks – a behavioral health organization. They are out of San Antonio Texas, but contract with LISWs in the area. We just made our first referrals so do not have an opinion yet. Their number is 1-888-365-6271
· The Social Worker may want to try Deer Oaks. Their website is: www.deeroaks.com. I have heard of several facilities using their agency for counseling services. Here is an excerpt from their website (I was unable to include this portion of the email-contact me and I’ll forward the email or google the website yourself – Ceci Johnson, email@example.com)
Would you please send out a request asking the other social workers if they know of an official form that is designated for a resident to sign when a room change is made?
Thanks, Patti Abram, Social Services Director, The Village, A WesleyLife Community
We use one at Fleur Heights Care Center. – Cynthia Targoff
Be sure the form is also signed by the POA and/or guardian if the case warrants. – Jacqueline Dollar
When we have a room change, I document it in the interdisciplinary notes the family was notified or the family requested and they then sign the note as well. Patti Brekken
We do NOT. But it would be great to have one. Thanks. Has anyone heard any more about a new rule in January 2013 ?? If a person was in a private room and then applied for title 19 and was going on title 19 that family could pay the difference of the reimbursement from title 19 and what a private room would cost? -Luanne Kustra, Carroll, IA
I don’t have a specific form. I or the nurses document the following info: reason for room change; resident/family/new roommate/new roommate’s family being informed of change, as well as room rate changes; and follow up after the room change (to see if things are going well), documenting that or making any adjustments needed. – Lori Miller, Bishop Drumm, Johnston
We have never used a form – someone just documents in the chart. It would be great to know if we are supposed to have a form. Thanks. - -Leisa Osterhaus
We do notification by phone, e mail only. – Mary Goodrich
Attached is the form we use at Sunrise Retirement for all room changes, AL to NF. The resident does not sign the form, but it reminds us to obtain consent, notify the resident and the family. We also offer a one week follow visit for support, etc. This form is then kept in the Social Services File in the event it is requested by DIA. I created this form myself in 2011 after a surveyor questioned a resident’s room change. Thanks! - LeAnn Fleming, LBSW, Social Services Director, Sunrise Retirement Community Form - http://www.ltcswi.com/Resident Room Change Consent 2011 (2) - Sunrise.pdf Here is Linn Havens. Merry Christmas! - Dorann Burgart Form - http://www.ltcswi.com/Room Change Agreement - Linn Haven.pdf This is the form that we use. Kristi Barnett, BSW, Grundy County Memorial Hospital Form - http://www.ltcswi.com/Notification of Room Change - Grundy Co.pdf We use the attached form, but do not have one that the resident signs. I hope this helps. –Connie Hadden Form - http://www.ltcswi.com/303 Room Transfer or Room Change Request - Westhaven.pdf
Attached is the form we use at Sunrise Retirement for all room changes, AL to NF. The resident does not sign the form, but it reminds us to obtain consent, notify the resident and the family. We also offer a one week follow visit for support, etc. This form is then kept in the Social Services File in the event it is requested by DIA. I created this form myself in 2011 after a surveyor questioned a resident’s room change. Thanks! - LeAnn Fleming, LBSW, Social Services Director, Sunrise Retirement Community Form - http://www.ltcswi.com/Resident Room Change Consent 2011 (2) - Sunrise.pdf
Here is Linn Havens. Merry Christmas! - Dorann Burgart Form - http://www.ltcswi.com/Room Change Agreement - Linn Haven.pdf
This is the form that we use. Kristi Barnett, BSW, Grundy County Memorial Hospital Form - http://www.ltcswi.com/Notification of Room Change - Grundy Co.pdf
We use the attached form, but do not have one that the resident signs. I hope this helps. –Connie Hadden Form - http://www.ltcswi.com/303 Room Transfer or Room Change Request - Westhaven.pdf