Thursday, March 28, 2019

AHCA Webinar on Five-Star Changes in April

research@ahca.org

AHCA will host a webinar on Monday, April 8 at 12:30 p.m. Eastern on the new CMS Five-Star Rating System changes that will be published on Nursing Home Compare in late April. 

As a reminder, on March 5, the Centers for Medicare & Medicaid Services (CMS) issued a memorandum, "April 2019 Improvements to Nursing Home Compare and the Five Star Rating System," announcing several updates to all three components of the system—survey, staffing and quality measures—that will cause your star ratings to change. A detailed AHCA member summary can be found here and the updated Technical Users' Guide here.
 
Highlights of the changes are:
  • CMS will end the survey freeze on the health inspection domain of Five Star and will resume the traditional method of calculating the health inspection scores by using three cycles of inspections.
  • Nursing Home Compare will begin to report separate ratings for short-stay quality measures and long-stay quality measures. With the introduction of these separate ratings, the thresholds for quality measures will increase every six months.
  • Additionally, two measures are being added to the quality measure domain, which include long-stay hospitalization and long-stay Emergency Department (ED) visits. The long-stay physical restraints measure will be removed from the quality measure rating. The short-stay pressure ulcer and short-stay discharge community measures currently used will be replaced with their analogous Quality Reporting Program (QRP) measures.
  • CMS will be adjusting the thresholds for overall staffing ratings, which will provide a greater emphasis on RN staffing.
  • CMS will give a one-star staffing rating to those facilities that report four or more days without an RN in a quarter.

Please join us to learn more about these important updates and how the changes will impact your ratings.

Webinar Details

Title: The Stars are Changing - What Will Happen to Your Five-Star Rating?

Date: Monday, April 8, 2019

Time: 12:30 p.m. - 1:30 p.m. Eastern

Speakers: Dr. David Gifford, AHCA SVP of Quality and Regulatory Affairs, and Kiran Sreenivas, MS CPHQ, AHCA Research Director

Webinar Link: http://eventcenter.commpartners.com/se/Rd/Mt.aspx?102332

Please plan to join the webinar 15 minutes prior to the scheduled start time by clicking here.

Quality Improvement from Quality Award Recipients, Applicants and Examiners

Erin Prendergast

This year, we’ve heard more than ever across the U.S. how the AHCA/NCAL National Quality Award Program has made a true difference within not only organizations as whole, but also within individuals themselves.

In 2018, AHCA/NCAL recognized four organizations with a Gold – Excellence in Quality Award, the highest of three distinct levels possible through the AHCA/NCAL National Quality Award Program. Two of those organizations, Maine Veterans Home–Machias and Sunrise of Gurnee, are the first free-standing assisted living communities to ever attain Gold in the history of the program. These two assisted living communities demonstrate that if a small, rural non-profit and a more urban community belonging to one of the nation’s largest companies can achieve the Gold, any assisted living community can. Watch how their Quality Award journey benefitted their organizations in more ways than one.

And like I mentioned, this program has not only affected companies. Individuals have seen firsthand how this program improves lives. During our Examiner training in February, we recognized one of our volunteers, Jacqueline Vance for her 10 years of service. Jacqueline recently shared how being a Quality Award Examiner has allowed her to impact quality improvement on a national scale. Read her story here.

We also heard Jerald Cosey, executive director of a skilled nursing facility, share his lessons learned applying for the Silver Quality Award. Giving tips, advice, and words of wisdom for his peers, Jerald and his team embody exactly what the Quality Award journey is all about – “Early in the application process, we realized it was never about winning. … When it’s all said and done, we have already won by completing an application worthy of review.”

These inspiring stories are just a few of many. There is so much more to tell, and so much more potential to witness excellence in quality. The 2019 Application review cycle is under way and applicants will be notified in June of their status. Materials and more information on the 2020 application cycle will be available on the AHCA/NCAL National Quality Award website in August.

Wednesday, March 27, 2019

NCAL’s 2018 Nurse of the Year Credits Gero Nurse Prep with Helping Her Pass the ANCC Board Certification Exam

Dave Kyllo

Amanda Garcia’s eight-year career as an assisted living RN at The Kensington in Fort Madison, Iowa is filled with accomplishments. She was the first in her county to become a facilitator and instructor for end-of-life care. She has trained staff at the local hospital and Iowa State Penitentiary in dementia care. She also received the Distinguished Director of Nursing in Leadership Award from the Iowa Center for Assisted Living, and, The Kensington received the Silver – Achievement in Quality Award through the AHCA/NCAL Quality Award Program. 

In between all that, Garcia studied for and passed the American Nurses Credentialing Center (ANCC) board certification exam in gerontological nursing – the gold standard in demonstrating knowledge and expertise in gerontological nursing. She credits the AHCA/NCAL Gero Nurse Prep on-line training course in preparing her to pass the exam.

“The course is amazing and prepares you very well to take the exam,” Garcia said. “It was a real confidence booster that I do know what I’m talking about.” She said that the Gero Nurse Prep course was more intensive than she expected. “There is so much that is different and more to learn with the geriatric population.” The Gero Nurse Prep case studies pushed the envelope in using her critical thinking skills, she explained. Ninety-six percent of Gero Nurse Prep students who take the ANCC Board certification exam in gerontological nursing pass on their first try.

Statistics also back up Garcia’s Gero Nurse Prep learning experience. Gero Nurse Prep students see a dramatic 24 percent average increase between their pre- and post- course test scores. Registered nurses who are interested in increasing their knowledge of gerontological nursing practice can complete the AHCA/NCAL Gero Nurse Prep course receive 30 nursing contact hours, and increase their skills and knowledge of geriatric nursing. RNs are also well prepared to sit for the ANCC Board certification test should they choose to pursue the “RN-BC” credential. 

Garcia said Gero Nurse Prep and becoming an ANCC Board certified RN made her a better assisted living nurse. “I have shared my knowledge with other nurses on staff and developed new practices and procedures for the facility,” she said. She explained that there is not a lot of resources for assisted living RNs but that she believes ANCC Board certification and Gero Nurse Prep are great avenues to help RNs become better gerontological nurses.  

Gero Nurse Prep is on sale! Save $100 off the regular registration fee now through April 30 by using promo code VBP2019 (all caps). AHCA/NCAL Gero Nurse Prep provides tremendous value at this AHCA/NCAL member $590 sale price. That’s less than $20 per contact hour for outstanding nursing education that makes a measurable difference on so many fronts. For RNs interested in pursuing Board certification through ANCC, there is an additional and separate cost of $395. 

To learn more about Gero Nurse Prep and ANCC Board certification, watch this video For an even deeper dive into competent geriatric nursing, listen to this free AHCA/NCAL webinar “Improving Clinical Outcomes through Competent Gerontological Nurses.”

If your assisted living RNs are not yet ANCC Board certified, take this important step on your quality improvement journey and check out AHCA/NCAL Gero Nurse Prep today.

SAMHSA Webinar: Improving Opioid Misuse Prevention Literacy Between Older Adults and Health Care Providers

Thursday, March 28, 2019, 2:00 to 3:30 PM ET
 
 
This is the fourth webinar by the Substance Abuse and Mental Health Services Administration as part of SAMHSA’s National Prevention Week (NPW) 2019 series developed to support organizations and communities working on the front lines of prevention.
 
Research suggests that substance misuse, especially opioid misuse, is a growing public health issue within the nation’s older adult population. Health challenges associated with aging, such as arthritis-related pain, back pain, or recovery from an injury or surgery, are leading more adults age 50 and older to seek prescriptions for opioid medications.
 
Patients, their caregivers, and health care providers need to know what questions to ask about opioids to improve health literacy regarding the substances. By improving health literacy, we can develop an effective prevention strategy for addressing the opioid crisis among older adults, including by helping them make more informed, healthier choices regarding their prescription drug use.
 
Confirmed speakers include:
  • David Lamont Wilson, NPW 2019 Coordinator, SAMHSA
  • Jennifer Solomon, MA, Public Health Analyst, SAMHSA
  • Kathleen A. Cameron, MPH, Senior Director, Center for Healthy Aging, National Council on Aging
 
 

Recent HHS Office of the Inspector General Report and SNF Payments

Dana Halvorson

On February 14, 2019, the Office of the Inspector General (OIG) released a report citing improper payments to SNFs when a qualifying three-inpatient nights hospital stay was not met.  Last month, McKnight’s issued an article on the report, and AHCA’s Clif Porter, Senior VP of Government Relations, is quoted.  Most recently, on March 25, 2019, a blog was published in Health Affairs titled, “What the Inspector General Gets Wrong About Reforming Observation Hospital Care.”  The blog article includes support for the Improving Access to Medicare Coverage Act of 2019 (H.R. 1682/S. 753).  Introduced by Congressmen Joe Courtney (D-CT) and Glenn 'GT' Thompson (R-PA) and Senators Sherrod Brown (D-OH), Susan Collins (R-ME), Sheldon Whitehouse (D-RI) and Shelley Moore Capito (R-WV), the legislation ensures that time spent under “observation status” in a hospital counts toward satisfying the three-day inpatient hospital requirement for coverage of skilled nursing care services under Medicare.  For more information about the observation stays issue, please visit the AHCA/NCAL website.         

Tuesday, March 26, 2019

Make Your Community Vibrant with Music from Mood Media

Dave Kyllo

Famous American author Pat Conroy said, "without music, life is a journey through a desert." Members can quench their residents’ musical thirst through the music offered by Mood Media at AHCA/NCAL “Member Only” discounted rates.

Mood Media offers great musical variety for events or casual common area listening via the internet or streaming, and offers customized commercial free music options that allow facilities to tailor musical selections to meet changing resident preferences.  Mood customers enjoy freedom from music licensing worries on Mood Media’s huge collection of music selections played on Mood Media's portable devices.
Use Mood Media’s music to:
  • Improve the dining experience and set the mood in dining areas as residents gather for meals;
  • Provide a variety of background music in common areas;
  • Create a positive environment for activities; and
  • Provide musical entertainment for social gatherings and happy hours.

AHCA/NCAL members receive exclusive discounted rates on Mood services and equipment with three-year agreements.  The core music package starts at $29.99 per month or about $1 per day with a three-year agreement.    

For more information about Mood Media’s services, call 800-345-5000 or go to   http://partner.moodmedia.com/ahcancal/ (password: moodpartner).

Be PDPM Ready: Get Trained on ICD-10 Coding Now

Dave Kyllo

The October 1 PDPM implementation date is rapidly approaching and training key staff now to be ICD-10 proficient is critical. The American Health Care Association (AHCA) and the American Health Information Management Association (AHIMA) are offering ICD-10 on-line training. Because staff needs differ based their coding responsibilities, two specific trainings have been developed– one training for coders and a shorter less intense course for non-coders. 

AHCA/AHIMA ICD-10 Training for PDPM – Coder is an in-depth course designed for SNF billing staff, MDS staff, Nursing and Therapy staff, and Admissions and Discharge staff.  The course contains seven modules and comes with 16 CNEs for nurses and 16 AHIMA CEs upon successful completion.  The cost is $499 for AHCA members and $599 for non-members.

AHCA/AHIMA ICD-10 Training for PDPM – Non-Coder is a four-hour course developed for individuals who need to lead a successful PDPM transition and is intended for Administrators, DONs, and other management staff.  The course for non-coders comes with 4 CNEs for nurses, 4 AHHIMA CEs or 4.5 NAB approved CEs upon successful completion.  The cost is $199 for AHCA members and $249 for non-members.
 
With thousands of codes and changes based on the new Patient Driven Payment Model (PDPM), accurate ICD-10 coding is essential. PDPM relies on accurate patient assessments and diagnosis on the MDS and ICD-10 coding to determine payment for each patient. Inaccurate coding can negatively impact a facility’s bottom line and resident care.
 
To learn more or register for either on-line training, please visit the websites below.    
 
Members will need to login with their AHCA/NCAL usernames and passwords.  For assistance obtaining AHCA/NCAL usernames and passwords, please e-mail educate@ahca.org with your name and facility contact information. 

Nursing Facilities with ANCC Board Certified RNs Receive Fewer Deficiencies

Dave Kyllo

New research conducted by AHCA/NCAL shows that nursing facilities that employ at least one American Nurses Credentialing Center (ANCC) Board certified RN also performed better on average on their annual surveys.
   
Looking at statistics for the last two survey cycles, the national average number of citations was 7.53 and 7.55 respectively, while nursing facilities with at least one ANCC Board certified RN averaged 5.90 and 5.71 citations respectively.  Nursing facilities with at least one ANCC Board certified RN also averaged fewer Immediate Jeopardy (IJ) citations in the last three survey cycles when compared to facilities nationwide.
 
The ANCC offers certification in gerontological nursing – the gold standard in demonstrating clinical excellence in geriatric patient care.  ANCC is the world’s largest and most prestigious nurse credentialing organization and a subsidiary of the American Nurses Association.  Less than one percent of America’s RNs are board certified in gerontological nursing.
 
To help RNs prepare for the certification exam, AHCA/NCAL offers a course called Gero Nurse Prep. RNs who complete the course earn 30 nursing contact hours and experience a 96% pass rate on the ANCC certification exam on the first try. Gero Nurse Prep students see a whopping 24 percent average increase between their pre- and post-test scores.
 
Gero Nurse Prep is on sale!  Save $100 off the regular registration fee now through April 30 by using promo code VBP2019 (all caps). AHCA/NCAL Gero Nurse Prep provides tremendous value at this AHCA/NCAL member $590 sale price.   That’s less than $20 per contact hour for outstanding nursing education that makes a measurable difference on so many fronts.  For RNs interested in pursuing Board certification through ANCC, there is an additional and separate cost of $395.
 
To learn more about Gero Nurse Prep and ANCC Board certification, watch this video. For an even deeper dive into competent geriatric nursing, listen to this free AHCA/NCAL webinar “Improving Clinical Outcomes through Competent Gerontological Nurses.”
   
If your RNs are not yet ANCC Board certified, take this important step on your quality improvement journey and check out AHCA/NCAL Gero Nurse Prep today.        

New CMS Guidance on Home and Community-Based Services Settings Rule

Lilly Hummel

CMS has issued new guidance to states that address several issues regarding the Home and Community-Based Services (HCBS) Settings rule. CMS will have an FAQ training session on Thursday, March 28 from 1:30-3:30ET. You can register here to attend this training.

This guidance leaves unchanged the regulatory requirement that states send for CMS heightened scrutiny review those HCBS settings that are (1) co-located with an institutional setting, (2) in a building located on the grounds of or immediately adjacent to a public institution (e.g., county-owned nursing center), or (3) any other settings that have the effect of isolating beneficiaries.

The guidance provides some clarity on the following:
  • CMS clarifies the factors it will consider in determining whether a setting may have the effect of isolating individuals. 
  • CMS does not consider rural settings automatically presumed to be isolating and subject to heightened scrutiny. For settings in a rural area, just like for settings in any geographic area, states should refer to the factors used to determine whether a setting may have the effect of isolating individuals.
  • Given the large number of settings that are required by regulation to undergo heightened scrutiny, CMS will conduct its heightened scrutiny review via a random sampling process. The agency provides some detail on the random sampling selection, the three possible CMS responses to a review, and when states can provide CMS with additional information. CMS also provides a more detailed list on what information states should submit to CMS for those settings randomly selected to undergo heightened scrutiny review.
  • States are not expected to assess an individual’s private residence for compliance with the settings criteria when that resident receives non-residential HCBS. Additionally CMS does not require, but states have the option to require, that individuals receiving non-residential HCBS must reside in a compliant setting. For example, this could apply if a person receives adult day services but lives in a non-compliant setting.

Providers of Medicaid HCBS should stay tuned for new information from their state affiliates and Medicaid or Aging Departments.

Chief White House Correspondent at Fox News John Roberts Set To Be Congressional Briefing Featured Speaker

Danielle Levitan

John Roberts, Chief White House correspondent at Fox News is set to be the featured speaker at this year’s Congressional Briefing.

June 3-4, 2019
Hyatt Regency Washington on Capitol Hill
 
Congressional Briefing is a terrific opportunity to get an update on all that is happening in Washington, hear from exciting speakers, network with your colleagues and, most importantly, meet with your Members of Congress.

We encourage you to start setting up your meetings now. Contact your state associations to set up your Hill visits. If your state association is unable to help you e-mail  congressionalbriefing@ahca.org for assistance.

This is a valuable opportunity you don’t want to miss. See the complete agenda, get hotel information, and register at CB.ahcancal.org.

The advanced registration deadline is May 6, 2019.

The conference registration fee is complimentary to AHCA/NCAL Members and AHCA/NCAL Associate Business Members, and their spouses, and is accepted on a first-come basis. Registration for this event is exclusively for long term and post-acute care provider members of AHCA/NCAL and AHCA/NCAL Associate Business Members only. AHCA/NCAL reserves the right to grant final approval for all registrants to attend this conference.

Host Sponsor: Medline

Supporting Sponsors:Navigator Group Purchasing, Reliant Rehabilitation, Zimmet Services

Save the Date: CDC NHSN Annual Training for LTC in July

Holly Harmon

CDC is inviting long-term care facilities and partners to join them July 9-11, 2019 for the 2019 National Healthcare Safety Network’s (NHSN) Annual Training for Long-term Care Facilities (LTCF). The training will be held at the Centers for Disease Control and Prevention (CDC) campus in Atlanta, Georgia and will cover a variety of topics, including the application of the NHSN LTCF surveillance protocols, antibiotic stewardship, and data analysis for action.

The training is open to current NHSN LTCF users, as well as LTCF staff from centers that may be interested in enrolling and participating in NHSN. The NHSN User Support Team will be available onsite to help current and new users with the beginning steps of participation like facility set-up and more.

New this year, the Secure Access Management Services (SAMS) Team will be onsite to help new users gain access to NHSN! The SAMS Team will assist with SAMS registration, including the issuance of the grid card needed to securely access NHSN. This is a great opportunity for new facilities and users to take advantage of personalized enrollment support.

Please stay tuned for additional information. In the meantime, any questions about the annual training should be emailed NHSNtrain@cdc.gov.

#WhyICare Workforce Campaign

Cristina Crawford

AHCA/NCAL is launching a new workforce campaign to attract and retain talented caregivers by showcasing the numerous career opportunities available in long term care. The campaign, Why I Care, will broadcast the stories of individuals in the profession. This month, we created two new videos that highlight the careers of Lakesha Boston, a CNA who shares her passion for helping others, and Patricia Ebanks, a nurse who started out working in housekeeping, worked her way up, got her nursing degree, and isn’t done yet.

You can access the videos on our YouTube page here, and we encourage you to share these stories on your digital platforms using the hashtag #WhyICare.

Please email Rachel Reeves or Cristina Crawford with any questions or workforce stories you would like to share.

Friday, March 22, 2019

Careers in Aging Week Wrap Up

Lindsay Schwartz

This year, AHCA/NCAL supported the Gerontological Society of America’s (GSA) Careers in Aging Week (CIAW), which took place March 3-9. The goal of CIAW is to bring awareness to the numerous career opportunities in aging. Along with Argentum and LeadingAge, we spread the word about careers in aging and celebrating our current employees. We hope everyone had a great celebration!

Just because CIAW is over, doesn’t mean we can’t continue our momentum. All of the activities mentioned in our one-pager can be done anytime of the year including visiting schools to talk about careers in aging, celebrating staff, and participating in job fairs to name a few. Listen to and share brief podcast interviews with staff from all different careers in aging including a CNA, RN, Executive Director/Administrator, HR expert, Director of Culinary services and many more! Need other ideas and resources? Check out the AHCA/NCAL Workforce Resource Center.

Reflections on Nursing Center Quality since 2011

Kiran Sreenivas

I recently rediscovered a 5-minute YouTube video on the aspirations behind launching the 2011 AHCA/NCAL Quality Initiative. Upon hearing the call to reduce readmissions and transition to person-centered care, it is comforting to know the call is being answered based on the latest available data.

Since 2011, the number of people returning to hospitals has declined by 11.6%. As the video points out, reducing readmissions is not just about reducing health care costs. It is what is best for the patient. Studies have shown readmitted patients are four times as likely as non-readmitted patients to die in the 100 days post-hospital discharge.

The reduction in readmissions is not by accident. It reflects the improvement made across 18 quality measures, including a 20% reduction in pressure ulcers and a 61% decrease in urinary tract infections. Eliminating these adverse events means fewer patients needing to go to the hospital to get acute care to address these conditions.

In addition to patients not wanting to go back to the hospital or experience adverse events, they also do not want to experience pain. In 2011, one out of every eight patients reported experiencing pain. Today, we have one out of every 18 patients experiencing pain. This demonstrates efforts made to listen to patients and progress towards person-centered care.

In addition to listening, person-centered care is about helping patients live life according to their individual values. Often time that includes being with friends and family and living at home, which is why it is important that nearly two-thirds of patients admitted to skilled nursing centers return safely to the community. And this rate continues to improve.

The gains made since 2011 do not signify the end of progress. There is still more that can be done. For example, data shows Silver and Gold recipients of AHCA/NCAL National Quality Award Program have better outcomes than others. And while every year we see more centers start and continue the Baldrige journey, currently only 30% of the nations 15,000 plus nursing centers are part of the journey.

I am excited to see the achievements we can highlight in the next eight years.

Wednesday, March 20, 2019

Career Pathways Website Expands to 17 States

Cristina Crawford

This week, it was announced that 17 long term and post-acute care associations across the U.S. have joined forces to address caregiver shortages in their states with CareForTheAging.org, a workforce website originally launched in 2017 by the Indiana Health Care Association/Indiana Center for Assisted Living’s (IHCA/INCAL). The expansion brings the robust capabilities of the website to 17 new state-specific CareForTheAging.org sites through a collective effort aimed at increasing awareness of career pathways and boosting workforce recruitment in the long term and post-acute care sector.

These states include: Arizona, Colorado, Connecticut, Georgia, Idaho, Illinois, Massachusetts, Maryland, Michigan, Minnesota, Nebraska, New Hampshire, North Dakota, Ohio, Texas, Virginia and Wisconsin.

The expansion of the site also comes with a significant enhancement in functionality — the newly launched member portal that gives providers direct access to candidate interest forms that are submitted by site visitors seeking new career opportunities. The member portal accelerates the recruitment process creating opportunities for them to initiate timely outreach with qualified candidates. Using the member portal, recruiters will be able to receive instant notifications via email about candidate interest form submissions, and filter and export submissions by zip codes, education, date and other pre-defined variables.

CareForTheAging.org offers comprehensive information on the diverse career pathways available in long term care. The site features a wealth of resources including state-specific education requirements, salaries and career-focused videos by caregivers to inspire those seeking new opportunities to pursue a career in this exceptionally rewarding field.

High school students, early career professionals and job seekers searching for new career opportunities are encouraged to visit https://carefortheaging.org/ to get connected with resources and employers.

CMS Training on HCBS Provider Risk Assessments and Mitigation Strategies

Lilly Hummel

The Centers for Medicare and Medicaid Services (CMS) has announced a webinar on April 3, 20 from 2:30-4:00ET to provide the comprehensive elements of a risk assessment and mitigation strategies. You can register for the training here. According to CMS, the elements that will be covered include

- An assessment process to identify risks;
- Development of individualized plans to address risks;
- Monitoring activities to modify plans as needed;
- A process to train and educate staff; and
- Ongoing system wide quality improvement in home and community-based programs.

The session will also include a review of federal regulations that support the health and welfare of HCBS waiver participants and an overview of the 2018 Interagency Report entitled Ensuring Beneficiary Health and Safety in Group Homes Through State Implementation of Comprehensive Compliance Oversight. AHCA/NCAL encourages all Medicaid HCBS providers to attend to learn more about what CMS considers to be best practices.

Monday, March 18, 2019

It’s Easy to Stop Over Paying Utility Companies and it Won’t Add to Your Bottom Line

Dave Kyllo 

Most long term care facilities (about 75%) are being overcharged for one or more of their utilities and these overpayments are wasted dollars out the door. Providers don’t receive better service or any other benefit for over paying utility companies. The good news is that putting an end to the overpayments is easy.

Cleary Energy is a AHCA/NCAL preferred provider and has recouped on average 4% to 8% savings on utilities for long term care facility customers. That’s a significant savings! 

Cleary Energy performs utility bill audits by examining utility, supplier and government charges on utility bills to obtain refunds and/or credits and rate reductions. Specifically, Cleary Energy audits a facility’s electric, natural gas, propane, heating oil, diesel fuel, water, sewer and telecommunications bills. 

The program is designed to save AHCA/NCAL members significant money on their utility bills without adding new expenses to their budgets. Cleary Energy guarantees savings or its auditing services are free. Cleary Energy’s fees are based on facility savings on their utility bills. 

AHCA/NCAL member facilities enter into an audit agreement with Cleary Energy, which is a shared savings agreement that lasts for a period of three years. If no refund, savings or credits are received, the AHCA/NCAL member facility owes nothing to Cleary Energy for conducting the audit and AHCA/NCAL members will have the peace of mind of knowing that their facilities are not being overcharged for their utilities.   

The process for engaging Cleary Energy to conduct a utility audit is easy. Most of the information Cleary Energy needs to complete an audit comes directly from the utilities or suppliers. 

Cleary Energy’s long term care experience sets the company apart. The founder of Cleary Energy has 40 years of long term care experience and has spent the last seven years specializing in finding energy cost savings for skilled nursing, assisted living and senior living centers. That in-depth knowledge of long term care operations enables Cleary Energy to find the greatest costs savings on utility expenses for AHCA/NCAL members because Cleary Energy knows where to look for savings. 

Cleary Energy has been finding huge savings for AHCA/NCAL members, so now is the time to take advantage of this unique no-risk opportunity to save on utility costs. Contact Cleary Energy today in one of the three ways listed below. 

• www.ClearyEnergy.com
• Email: AHCA-NCAL@ClearyEnergy.com
• Phone: (203) 416-6568

Average SNF VBP Performance Scores Are Higher in SNFs with ANCC Board Certified RNs

Dave Kyllo

New research conducted by AHCA/NCAL shows that SNFs that employ at least one American Nurses Credentialing Center (ANCC) Board certified RN also, on average, performed higher on SNF VBP performance. The net result is that these SNFs get higher Medicare Part A reimbursements.
 
The average 2017 SNF VBP performance score across the nation was 34.4. For SNFs with at least one RN who has been ANCC Board certified in gerontological nursing, the average SNF VBP performance score was 44.2. The SNF VBP performance score is used to determine how much of the automatic 2% Medicare Part A withhold is returned to a SNF. 

The ANCC offers certification in gerontological nursing – the gold standard in demonstrating clinical excellence in geriatric patient care. ANCC is the world’s largest and most prestigious nurse credentialing organization and a subsidiary of the American Nurses Association.  Less than one percent of America’s RNs are board certified in gerontological nursing. 

To help RNs prepare for the certification exam, AHCA/NCAL offers a course called Gero Nurse Prep. RNs who complete the course earn 30 nursing contact hours and experience a 96% pass rate on the ANCC certification exam on the first try. Gero Nurse Prep students see a whopping 24 percent average increase between their pre- and post-test scores. 

Gero Nurse Prep is on sale! Save $100 off the regular registration fee now through April 30 by using promo code VBP2019 (all caps). AHCA/NCAL Gero Nurse Prep provides tremendous value at this AHCA/NCAL member $590 sale price. That’s less than $20 per contact hour for outstanding nursing education that makes a measurable difference on so many fronts. For RNs interested in pursuing Board certification through ANCC, there is an additional and separate cost of $395. 

To learn more about Gero Nurse Prep and ANCC Board certification, watch this video. For an even deeper dive into competent geriatric nursing, listen to this free AHCA/NCAL webinar “Improving Clinical Outcomes through Competent Gerontological Nurses.”   

If your RNs are not yet ANCC Board certified, take this important step on your quality journey and check out AHCA/NCAL Gero Nurse Prep today.        

Thursday, March 14, 2019

Liability Data Collection - Participants Needed

AHCA/NCAL partners with Aon to produce reliable estimates of liability costs for long term care. Aon launched the data call for the Aon 2019 General and Professional Liability Benchmark for Long Term Care Providers. As a member of the IO Council you are invited to participate confidentially. As a participant, you will receive an advance, electronic copy of the report prior to its public release in October 2019. All submissions must be received by Monday, April 15.

Please visit Aon’s website here to participate.

Wednesday, March 13, 2019

Deadline Extended! State of Seniors Housing Survey 2019

Lilly Hummel

Great news - you still have time to contribute to the quintessential report on financial performance in the senior housing industry. The deadline to participate in the 2019 State of Seniors Housing Survey has been extended to Monday, April 22, 2019.

Please download the survey (Excel format) and submit completed surveys to colleen.blumenthal@healthtrust.com. Questions about the survey should be directed to Colleen Blumenthal of HealthTrust, LLC at (941) 363-7502 or at her email address noted above.

For more information on the report and why you should participate, please check out our blog post from last month. 

To purchase last year's State of Seniors Housing Report, visit the AHCA/NCAL Bookstore

Registration Is Now Open!

Join us in Washington, D.C. for an invaluable opportunity to speak your mind.
June 3-4, 2019
Hyatt Regency Washington on Capitol Hill
 

Congressional Briefing offers you the chance to

• Meet with your Members of Congress face to face
• Network with your colleagues
• Get an update on what's happening on the Hill
• Hear from terrific speakers
Featured Speaker:
John Roberts, Chief White House correspondent, FOX News

Featured Speaker John Roberts
See the complete agenda, get hotel information, and register at CB.ahcancal.org.

The advanced registration deadline is May 6, 2019.

The conference registration fee is complimentary to AHCA/NCAL Members and AHCA/NCAL Associate Business Members, and their spouses, and is accepted on a first-come basis. Registration for this event is exclusively for long term and post-acute care provider members of AHCA/NCAL and AHCA/NCAL Associate Business Members only. AHCA/NCAL reserves the right to grant final approval for all registrants to attend this conference.

Host Sponsor: Medline
Supporting Sponsors:Navigator Group Purchasing, Reliant Rehabilitation, Zimmet Services

The Number of Open LTC Jobs Nationwide Nears 48,000 in March

Dave Kyllo

There are 47,922 open jobs posted by direct employers in the nursing care facility (including SNFs), assisted living, and continuing care retirement community (CCRC) sectors this month according to the latest Gartner TalentNeuron statistics. That represents an increase of more than 4,300 open jobs compared to January figures.   
    
The Gartner TalentNeuron statistics also show an estimated 2,661,000 potential candidates in the nation’s workforce whose skills likely match the qualifications being sought by long term care employers. Figures show that 3,058 direct employers are competing for candidates this month which is a slight increase over January. The average number of days a job was posted was 32 days in March.      

Finding qualified employees is one of the greatest challenges facing long term care providers and early 2019 statistics prove that the challenge is only growing in the strong economy with a low unemployment rate. Lead them to your job vacancy through the AHCA/NCAL Long Term Care Career Center

The LTC Career Center is designed to help AHCA/NCAL members be competitive in attracting qualified candidates to fill their health care positions. Job postings receive far greater exposure than local ads and job boards because the LTC Career Center connects to a national network of nearly 300 national and state health care organizations and societies where serious candidates look for health care jobs. Employers are also able to post vacancies as they occur and search resumes on the network.

Rates for posting job vacancies are affordable at $350 for a 30-day job posting. Employers who utilize the site also receive complimentary additional exposure through rotating new job listings on AHCA’s home page – the web site where long term care professionals go for news and information.  In addition, employers who post vacancies through the center receive free bonus rotating listings on the Long Term Care Career Center home page. 

Of course, the LTC Career Center is always free for job seekers and the LTC Career Center features many of the best positions the long term care profession has to offer. Job seekers are using the site with more than 64,000 searchable resumes on the National Healthcare Career Network this month.  

Join the high profile employers that use AHCA/NCAL’s premier member resource to find top talent.  Check out the LTC Career Center or call Robin at 866-964-2765 x2736 for more information about posting job vacancies on the LTC Career Center and other discounted job listing packages.   

Celebrate Certified Nurses on March 19 by Giving the Gift of Knowledge

Dave Kyllo

Certified Nurses Day™, held annually on March 19, honors nurses worldwide who contribute to better patient outcomes through national board certification in their specialty. A registered nurse (RN) license allows nurses to practice. Certification affirms advanced knowledge, skill, and practice to meet the challenges of modern nursing.

The American Nurses Credentialing Center (ANCC) offers certification in gerontological nursing – the gold standard in demonstrating clinical excellence in geriatric patient care.  ANCC is the world’s largest and most prestigious nurse credentialing organization and a subsidiary of the American Nurses Association. Less than one percent of America’s RNs are board certified in gerontological nursing. 

To help RNs prepare for the certification exam, AHCA/NCAL offers a course called Gero Nurse Prep. RNs who complete the course earn 30 nursing contact hours and experience a 96% pass rate on the ANCC certification exam on the first try. Gero Nurse Prep students see a whopping 24 percent average increase between their pre- and post-test scores. 

Gero Nurse Prep is on sale! Save $100 off the regular registration fee now through April 30 by using promo code VBP2019 (all caps). AHCA/NCAL Gero Nurse Prep provides tremendous value at this AHCA/NCAL member $590 sale price. That’s less than $20 per contact hour for outstanding nursing education that makes a measurable difference on so many fronts. For RNs interested in pursuing Board certification through ANCC, there is an additional and separate cost of $395. 

There are three easy ways to learn more about Gero Nurse Prep and ANCC Board certification:

1. Watch this video to learn more about AHCA/NCAL Gero Nurse Prep and build a strong geriatric nursing team with AHCA/NCAL Gero Nurse Prep.  

2. For an even deeper dive into competent geriatric nursing, watch this free AHCA/NCAL webinar “Improving Clinical Outcomes through Competent Gerontological Nurses.” 
 
3. Attend the Monday, March 18 AHCA/NCAL Quality Symposium session in Tampa at 1 p.m. titled “Competent Geriatric RNs – The New Driver of Financial Performance.” The session will feature the latest AHCA/NCAL research showing the impact Board certified RNs have on key quality indicators, survey citations and reimbursement.   
AHCA/NCAL encourages members to recognize their certified nurses on March 19. If your RNs are not yet ANCC Board certified, take this important step on your quality journey and check out AHCA/NCAL Gero Nurse Prep today.       

ICD-10 Online Training: Ensure Your Staff are Proficient & Ready

Jon Patrick-Ewing

With thousands of codes and changes based on the new Patient Driven Payment Model (PDPM), accurate ICD-10 coding is critical. PDPM relies on accurate patient assessments and diagnosis on the MDS and IDC-10 coding to determine payment for each patient. Inaccurate coding can impact your organization’s bottom line and resident care.

With so much to do before the October 1 implementation deadline, training key staff just got easier! The American Health Care Association (AHCA) and the American Health Information Management Association (AHIMA) is now offering ICD-10 on-line training. Because staff needs defer based on the responsibilities of coding, two specific trainings have been developed: AHCA/AHIMA ICD-10 Training for PDPM -- Coders and AHCA/AHIMA ICD-10 Training for PDPM – Non-Coders.

To learn more and to sign up for the trainings visit or download this form:

WEBINAR - So You Think You Might Want to Run for the AHCA or NCAL Board: Everything You Want to Know but Are Afraid to Ask

Friday, April 12, 2019
1:00pm – 2:00pm Eastern Time (one hour)

AHCA and NCAL members in good standing may apply for the 2019-20 elections for the AHCA Board of Governors and the NCAL Board of Directors. This webinar will explain the application, credentialing and campaign process. It is perfect for those interested in running this year or in future years.

Presenters: Tom Coble, President & CEO, Elmbrook Management Company, Chris Mason, President & CEO, Senior Housing Managers, LLC and Christy Herle, Senior Director Member Services, AHCA/NCAL.

Registration Link:  https://educate.ahcancal.org/p/190412

Updated List of Excluded Individuals and Entities (LEIE) Database File

Lilly Hummel

The US Department of Health and Human Services, Office of Inspector General (OIG) has released its updated List of Excluded Individuals and Entities (LEIE) database file, which reflects all OIG exclusions and reinstatement actions up to, and including, those taken in February 2019. This new file replaces the updated LEIE database file available for download last month. Individuals and entities that have been reinstated to the federal health care programs are not included in this file.

The updated files are posted on OIG’s website at http://www.oig.hhs.gov/exclusions/exclusions_list.asp, and healthcare providers have an “affirmative duty” to check to ensure that excluded individuals are not working in their facilities or face significant fines.

Instructional videos explaining how to use the online database and the downloadable files are available at http://oig.hhs.gov/exclusions/download.asp.

As a best practice, long term care providers should check the LEIE on a regular basis.

Wednesday, March 6, 2019

AHCA’s David Gifford Testifies in Front of Senate Finance Committee

Drew Thies

Today, David Gifford, MD, MPH, Senior Vice President of Quality at the American Health Care Association testified before the Senate Finance Committee to address concerns and instances of abuse and neglect in nursing centers.

The hearing, titled “Not Forgotten: Protecting Americans From Abuse and Neglect in Nursing Homes,” was called in response to two instances of abuse and neglect that happened to individuals in Iowa and Minnesota. The daughters of those individuals, Patricia Blank and Maya Fischer, also testified before the committee to tell their stories.

Gifford denounced abuse and neglect in nursing centers, saying they should never occur. “Families and residents like you and your mothers, who are often at their most vulnerable and in the most need of care and support, should never have to worry about their physical safety” he said during his opening remarks.

“AHCA remains committed to reducing any future cases of abuse and neglect.” Gifford said in a statement. “Since we voluntarily launched our Quality Initiative in 2012, we have seen tremendous improvements in the quality of care provided to nursing home residents. Care at our members’ nursing homes continues to improve and remain high for 18 of the 24 quality outcomes measured by the Centers for Medicare & Medicaid Services (CMS), including fewer residents receiving antipsychotic medications and more people returning home after rehabilitation care.

Gifford said that AHCA is offering solutions to help reduce instances of neglect and abuse. He said the main driver of quality is staffing and said incentives like a federal loan forgiveness program for nursing center staff. He also said that nursing centers should have access to a national background check registry and that resident and family satisfaction ratings of nursing homes should be publicly available.

“AHCA stands ready to work with Congress, members of the Senate Finance Committee, CMS, and other providers to keep residents safe and continue improving the quality of care provided,” he said in a statement.

Trauma-Informed Care Providing Mental Health Services in Long Term Care

Trauma-Informed Care Providing Mental Health Services in Long Term Care
April 24, 2019
2 PM EDT

As the numbers of adult residents impacted by PTSD, mental disorders, brain injury, and substance use disorders continue to increase in long term care, ensuring staff possess the competency and skill sets to address mental health will take on a new significance. Maintaining a caregiving environment that supports positive psychosocial functioning requires that staff understand how PTSD, mental disorders, brain injury, and substance use disorders differ from dementia to ensure appropriate care and services are provided.  This session offers a framework for developing an assessment and person-centered approach to care planning that will prove successful for this emerging population of younger, more complicated adults.

Learning Objectives:  At the conclusion of this session, participants will be able to:
  1. Explain the importance of a holistic assessment in meeting the mental health needs of adult residents impacted by PTSD, mental disorders, brain injury, and substance use disorders;
  2. Describe the systems and approaches utilized to improve access to clinical and psychosocial support and resources; and
  3. Demonstrate how meeting the mental health needs of adult residents impacted PTSD, mental disorders, brain injury, and substance use disorder improves mood and behavior, and enhances quality of life.
Speaker: Barbara Speedling, Quality of Life Specialist

How are you celebrating Careers in Aging Week?

Cristina Crawford

This week marks Careers in Aging Week, an entire week dedicated to bringing greater awareness and visibility to the wide-ranging career opportunities in the profession of aging. This week, we’ve seen fantastic stories from individuals across the country sharing why they love to work in long term care. From nurses, to chefs, to social workers, there’s no one-size-fits-all for a career in the field of aging, and the opportunities are endless. Check out some social media highlights so far:


And stay tuned for more stories! Contribute to the conversation on social media using #CareersInAging19 and tell us how you’re celebrating, or follow us on Twitter and Facebook to find resources, stories, and more.

Learn more about how you can celebrate by visiting www.careersinaging.com

Five-Star and Nursing Home Compare Change

 
Yesterday, the Centers for Medicare & Medicaid Services (CMS) issued a memorandum, "April 2019 Improvements to Nursing Home Compare and the Five Star Rating System," about changes to the  Five-Star Rating system on Nursing Home Compare that will go into effect in April 2019. CMS has also posted a revised Technical Users' Guide reflecting these changes.
 
Highlights of the changes are:
  • CMS will end the survey freeze on the health inspection domain of Five Star and will resume the traditional method of calculating the health inspection scores by using three cycles of inspections.
  • Nursing Home Compare will begin to report separate ratings for short-stay quality measures and long-stay quality measures. With the introduction of these separate ratings, the thresholds for quality measures will increase every six months.
  • Additionally, two measures are being added to the quality measure domain, which include long-stay hospitalization and long-stay Emergency Department (ED) visits. The long-stay physical restraints measure will be removed from the quality measure rating. The short-stay pressure ulcer and short-stay discharge community measures currently used will be replaced with their analogous Quality Reporting Program (QRP) measures.
  • CMS will be adjusting the thresholds for overall staffing ratings, which will provide a greater emphasis on RN staffing.
  • CMS will give a one-star staffing rating to those facilities that report four or more days without an RN in a quarter.

Click here for a more detailed summary.
 
AHCA will continue to provide updates on these changes. If you have any questions, please contact research@ahca.org.  

AHCA/NCAL ID/DD Fly-In Participants Storm the Hill

 


This morning, AHCA/NCAL’s Intellectual and Developmental Disabilities (ID/DD)  Residential Services Provider participants heard from Congressional speakers and others, including Congressman Steven Horsford of Nevada. Afterward, ID/DD providers headed to Capitol Hill and met with their members of Congress to discuss critical issues, such as Medicaid and workforce.

If you have any questions about this annual event, please don’t hesitate to contact Dana Halvorson.

Tuesday, March 5, 2019

New SNF Provider Threshold Report Now Available

Holly Harmon

The new Skilled Nursing Facility (SNF) Provider Threshold Report (PTR) is now available. This PTR is a user-requested, on demand report which enables users to obtain the status of their data submission completeness related to the compliance threshold required for the SNF Quality Reporting Program (QRP).

Currently, Fiscal Year (FY) 2020 and FY2021 are available for user selection for this report to assist providers in reviewing Calendar Year (CY) 2018 and CY2019 data submission. The SNF PTR will display an asterisk (*) for future dates (monthly and quarterly) when a measure is active, but data are not available yet.

This report is available in the ‘SNF Quality Reporting Program’ category in the CASPER Reporting application. Please refer to Section 13-SNF Quality Reporting Program in the CASPER Reporting MDS Provider User’s Guide for additional information about this report.

The CASPER Reporting User’s Guide is available on the 'Welcome to the CMS QIES Systems for Providers' web page and the Nursing Home (MDS)/Swing Bed Providers Reference & Manuals page on the QIES Technical Support Office (QTSO) website (https://qtso.cms.gov/providers/nursing-home-mdsswing-bed-providers/reference-manuals).

Coming Soon to Every Nursing Facility Near You: Specially Trained Infection Preventionists

Dave Kyllo

Phase III Requirements of Participation (ROP) take effect November 28, 2019 and mandate that every nursing facility have a designated and specially trained Infection Preventionist who is running a comprehensive infection prevention and control program.  AHCA’s Infection Preventionist Specialized Training (IPCO) program is specifically designed to prepare individuals to effectively implement and manage an Infection Prevention & Control program in nursing facilities.

AHCA’s course is an online, self-study program with 23 hours of training that meets the educational requirements outlined by CMS. It includes online lectures, case studies and interactive components taught by subject matter experts who have real life experience working in long term/post-acute care.  It addresses both clinical and organizational systems, processes and cultural aspects of infection prevention and control which are fundamental to effectively leading and administering a center’s Infection Prevention & Control program.  

Another reason for nursing facility staff to take the course now is to reduce the risk of receiving the most frequently cited F-Tag in standard nursing facility health inspection surveys under the new survey process is F880 – Infection Prevention & Control.  Since November 2017 when the new infection prevention and control mandates began, more than one-third of surveys conducted across the nation have included a F880 Infection Prevention & Control citation.  The primary change coming this November under Phase III ROP is the designation of a specially trained Infection Preventionist who must work at least part-time at the facility.   

The AHCA training program gets rave reviews with nearly 97 percent of health care professionals who have completed the course recommending IPCO to their colleagues. The registration fee is $450 for AHCA/NCAL members and $650 for non-members.  There are no refunds and no transfers.

Payment and registration are made online at ahcancalED.  The IPCO course can be accessed here or at: https://educate.ahcancal.org/p/ipco.   Discounted group purchase rates are available for groups of 25 or more.  Those interested in making a group purchase should email AHCA at educate@ahca.org.  

While CMS has announced plans to offer a free infection prevention training course some time in Spring 2019, no specific date has been announced yet.  AHCA/NCAL recommends investing in staff training now rather than waiting to train staff on the requirements that already are in effect.  Facilities will continue to be surveyed on all the new infection prevention and control requirements and the antibiotic stewardship requirements. 

To access ahcancalED and the IPCO course, members will need to login with their AHCA/NCAL usernames and passwords.  For assistance obtaining AHCA/NCAL usernames and passwords, please e-mail update@ahca.org with your name and facility contact information. 

National Long Term Care Administrator’s Week is the Perfect Time to Consider ACHCA Administrator Credentialing

Dave Kyllo

March 11-15, 2019 is National Long Term Care Administrator’s Week. During this week, staff, residents, families, and volunteers have the opportunity to say “thank you” and honor the Administrators who contribute to our nation’s long term care communities. The American College of Health Care Administrators (ACHCA) is the sponsor of Long Term Care Administrator’s Week.

Administrators are key players in the care team and are entrusted with the responsibility of caring for our loved ones. They touch the lives of residents and families, and most importantly, ensure that their staff provides the highest level of quality care to a vulnerable population.

AHCA/NCAL  partners with the ACHCA for its administrator certification programs.  The goals of the partnership are to increase awareness of advanced certification and professional growth opportunities and to encourage independent professional certification for nursing facility and assisted living administrators/directors. 

ACHCA has established eligibility criteria prior to taking the exam, including two years of licensure (other options exist for assisted living administrators in states without administrator licensure) and continuing education requirements.  Both must be established before an individual is authorized to sit for the credentialing exam. While ACHCA membership has many benefits for administrators/directors, ACHCA membership is not a requirement for ACHCA certification.

The application fee for either the nursing facility or assisted living certification exam is $150.   AHCA/NCAL members should use AHCA/NCAL members should use code AHCANCAL when they complete their initial ACHCA applications. The single credential fee (the fee paid after an individual passes the exam) is only $300 for AHCA/NCAL members, a $50 discount off the regular non-ACHCA member price when AHCA/NCAL members use promo code AHCANCAL at checkout. 

Credentialing through ACHCA lasts five years.  Recertification involves obtaining 150 hours of continuing education in five areas during the five-year certification period and paying a recertification fee.

ACHCA certification can provide State licensure reciprocity with certain states.  Licensing rules and requirements vary by state. Check with your state licensing board for your state’s reciprocity requirements. A list of state licensure boards and contact information is maintained on the NAB website at www.nabweb.org.

For more information about ACHCA certification, go to www.achca.org/certification or call 1-800-561-3148.  

A Prime Time to Build Geriatric Nursing Skills is When Gero Nurse Prep Goes on Sale

Dave Kyllo

AHCA/NCAL Gero Nurse Prep does much more than just prepare RNs to take the American Nurses Credentialing Center (ANCC) Board certification exam in gerontological nursing. It increases experienced RNs’ knowledge of gerontological nursing practice.  Gero Nurse Prep students see a whopping 24 percent average increase between their pre- and post-test scores. 

The statistics prove it.  Gero Nurse Prep grads know more about gerontological nursing.    Registered nurses who are interested in increasing their knowledge of gerontological nursing practice can complete the AHCA/NCAL Gero Nurse Prep course earn 30 ANCC contact hours (CEUs for nursing), and increase their skills and knowledge of geriatric nursing. 

For those RNs who are interested in ANCC Board certification, AHCA/NCAL Gero Nurse Prep thoroughly prepares them to take the ANCC board certification exam in gerontological nursing.  RNs who complete the Gero Nurse Prep program have a passing rate of 96 percent on the ANCC exam on their first try. 

Gero Nurse Prep is on sale!  Save $100 off the regular registration fee now through April 30 by using promo code VBP2019 (all caps).  AHCA/NCAL Gero Nurse Prep provides tremendous value at this AHCA/NCAL member $590 sale price.   That’s less than $20 per contact hour for outstanding nursing education that makes a measurable difference on so many fronts.  For RNs interested in pursuing Board certification through ANCC, there is an additional and separate cost of $395. 

There are three easy ways to learn more about Gero Nurse Prep and ANCC Board certification:
  1. Watch this video to learn more about AHCA/NCAL Gero Nurse Prep and build a strong geriatric nursing team with AHCA/NCAL Gero Nurse Prep.   
  2. For an even deeper dive into competent geriatric nursing, watch this free AHCA/NCAL webinar “Improving Clinical Outcomes through Competent Gerontological Nurses.”    
  3. Attend the Monday, March 18 AHCA/NCAL Quality Symposium session in Tampa at 1 p.m. titled “Competent Geriatric RNs – The New Driver of Financial Performance.”  The session will feature the latest AHCA/NCAL research showing the impact Board certified RNs have on key quality indicators, survey citations and reimbursement.   
ANCC is the world’s largest and most prestigious nurse credentialing organization and a subsidiary of the American Nurses Association.  Less than one percent of America’s RNs are board certified in gerontological nursing.