Taking Healthcare by Storm: Industry Insights with Pam Meador

In this captivating episode of Taking Healthcare by Storm, delve into the world of expert insights as Quality Insights Medical Director Dr. Jean Storm engages in a thought-provoking and informative discussion with Pam Meador, RN, BSN-BC, Director of Regulatory Services at the West Virginia Healthcare Association.

Pam Meador discusses the regulatory challenges, staffing issues, and infection control in long-term care facilities, emphasizing the importance of effective leadership and resident-centered care. She highlights the need for specialized training in long-term care and West Virginia's collaborative healthcare environment.

If you have any topics or guests you'd like to see on future episodes, reach out to us on our website.

Publication number QI-080125-GK

Transcript

 Welcome to "Taking Healthcare by Storm: Industry Insights," the podcast that delves into the captivating intersection of innovation, science, compassion, and care. 

In each episode, Quality Insights’ Medical Director Dr. Jean Storm will have the privilege of engaging with leading experts across diverse fields, including dieticians, pharmacists, and brave patients navigating their own healthcare journeys. 

Our mission is to bring you the best healthcare insights, drawing from the expertise of professionals across West Virginia, Pennsylvania and the nation.

Subscribe now, and together, we can take healthcare by storm.

Hello everyone and welcome to another episode of Taking Healthcare by Storm. I am Dr. Jean Storm, the medical director of Quality Insights, and I am very excited to have. Our guest with us today joining us is Pam Meador, R-N-B-S-N-B-C. She is the director of regulatory services for the West Virginia Healthcare Association, and I'm going to say I consider her.

The Queen of long-term care in West Virginia. If you are in West Virginia in long-term care, you know Pam's name with deep expertise in regulatory compliance, quality improvement, and policy implementation. She works on the front lines of ensuring that long-term care providers meet the highest standards of care.

We are gonna be discussing really important topics. Especially for long-term care facilities. Right now we're gonna be talking about FTags. We're gonna be talking about the ongoing impact of the pandemic on infection control, critical staff issues facing nursing homes, and then what the future holds for long-term care facilities, both in West Virginia and nationwide.

It's gonna be a really exciting conversation. This is. One of my favorite topics, and I think it's one of Pam's as well. So Pam, thank you very much for joining us. Oh, I'm so excited to be here. I was so excited when you asked me to be on. Good. I think it's a perfect time to have this conversation.

Absolutely, yes. So let's dive in something that is very important to long-term care facilities. Can you tell us what an FTag is and how it functions in the context of nursing home regulations and compliance and survey and all of that? Sure. An f tag that's kind of short for federal tag and basically it is a numerical system that CMS uses in order to give facilities an idea of what category the deficiencies fall under what the regulatory status is as far as scope and severity.

So it's basically a categorization. System that's found in appendix pp, which is as everybody who's been in long-term care knows as either the regulations or the watermelon book, which is the big pinkish looking book that everybody toted it around forever. And now it's online under cms.gov. So that's basically what an f tag is that facilities receive their deficiencies when they get their survey based on.

That's a really great explanation, and I will tell everyone if you are in long-term care you know about the five star system and all of that. But if you're not, and you're interested in doing more research on long-term care facilities or any healthcare facilities, really, you can go to the Medicare Compare site.

You just Google. Medicare compare nursing homes and you can get an idea of, you can pull up surveys from whatever nursing home you're looking at and it'll show you the F tags that those facilities have had challenges with. So I don't know about you, but I mean that's what I do in my spare time. I look at survey results.

I'm sure Pam, you do as well. Absolutely. Absolutely. And, And I think if you're a facility you should. Be very familiar with medicare.gov and be able to go in there and make sure that the surveys are accurate because they do make mistakes and they do. And it's for every John Q public to see what FTag or what deficiency you have received during your last several surveys.

Last three surveys. Yes. I agree. So what are the most pressing regulatory or operational challenges facing nursing homes in West Virginia? There are a few The first one that comes to my mind is staffing, of course, with every healthcare agency now from home health to hospitals, to doctor's offices, staffing especially with your registered nurses is a huge obstacle.

And I know it's something that the regulations are changing and they're gonna be requiring certain things as 24 hour RN coverage and all of those things later on down the road. But even staffing right now at the level it is, is very, very difficult. Another issue is, of course, keeping up with the regulatory requirements and the changes that go on every single solitary day.

 There's a, something has changed, something has increased, something has, you know, been modified. And you have to know how to keep up with those regulatory changes and make sure that your facility keeps, I mean, knowing about it's great, but if you don't implement it, then you're looking at even higher tags and civil money penalty fines and those kinds of things.

So keeping up with those regulatory requirements is a big one. one is leadership. Leadership within long-term care is something that you have to have excellent leaders in order to have an excellent facility. You can be a boss, but you. You need to be a leader and no, no long-term care,  it's not a focus in the schools.

Long-term care is its own beast. And people who come into, let's say nursing, and they've been an. RN for a year now, and they've worked, you know, basically in the hospital and then they come and they're like, Ooh, I could get a DON position. And they realize that it is an entirely different animal and you have to really be you really have to know long-term care in order to be a leader within that arena.

And I think the biggest for today's long-term care facility. Is that we are receiving younger residents with very complex mental illnesses, and we are expected to integrate those into our. Long-term care facilities with our elderly patients and our elderly long-term care residents.

And it's a huge challenge. These folks with mental illnesses or even the ones that have dementia, with the behavior issues, there's nowhere for them to go and get the care they need without putting others at risk. And both nursing homes and hospitals battle this daily who to keep at the facility, what can they do with them?

And then, you know, you've got the. The restrictions on antipsychotics in the facilities and the restrictions on physical restraints, which is all good things. Those are all good things, but it provides a huge barrier as to what we can do versus what hospitals can do. And it, it's one of the biggest I issues within the long-term care, both regulatory and operational within our, industry today.

Yeah, I could talk for so very long about that. But I wanna go back to your comment about directors of nursing or dns, and I just will tell everyone it's a, I mean, I've met many A DON in my career who I've just been inspired by, but it is a job that is more than 24 7.  it is such a challenging job, but when, you know, you find someone who's good at it, I mean, they are truly they're inspiring individuals, so  I would agree with you about that. Yeah. And they have to have the team behind them. You know, they're  it's the DON you're right, it is 24 7, 7 days a week.

But she's got to, or he has got to have. An excellent team behind them. They're an administrator. They're MDSs, they're, you know  they're charge nurses, they're nursing assistants, housekeeping, I mean, everybody is on the long-term care team. And, it's truly a team effort. And it shows when you walk in a facility, you know, immediately if it's a team effort or not.

So we're still kind of in the wake of the COVID pandemic. How has Infection control evolved in long-term care settings and what gaps do you see that still need to be addressed? COVID was such a huge part of everybody's life, but long-term care was impacted. I think, in my opinion, greater than anybody else.

 But as of today people are more aware of infection control. And I'm not just talking about your healthcare personnel, your not  your staff. I'm talking about families. Residents, visitors, the general public. Everybody notices if you don't wash your hands.  And that's, and again, that's a good thing that, you know, my mom, when she's in the hospital, she's scared to death of a germ germ. And she will, she'll. Mention it to somebody, could, even the physicians, could you please wash your hands before we do this?  and that's a great thing, patients  really grasped their own protection as far, and I believe that's Much of that has come from COVID. It's always been a regulatory issue for long-term care, infection control, but now it's its own category.

It's its own. Beast, if you will. For example, your enhanced barrier precautions, which is kind of complicated You have to know exactly what to do, exactly how to do it, and exactly how to explain it to  your residents and visitors, because long-term care is the only one that has enhanced barrier precautions.

So you have to be able to explain that to. Your caregivers and your residents and your families and your visitors. But when they go to the hospital, that's not an issue. So they don't understand, and that is a huge gap. It's a very difficult, in my opinion, it's a very difficult program for facilities to be able to both embrace and do perfectly at.

Because it is surveyed and it's surveyed heavily. They watch that. They watch because surveyors do have an understanding of it and they watch that very, very closely.  But the education as far enhanced barrier precautions is something that a lot of facilities have a gap in. Yeah I, I will definitely agree is I've given webinars on enhanced barrier precautions, and I had, I think we had so many questions we had to like.

Cut it off 'cause we ran out of time. I'll bet. I'll bet. So we talked a, you talked a little bit about staffing. Shortages are huge. Turnover is a problem. They've been a problem. They're more of a problem now, I think I read a statistic that staffing shortages affect like 99% of nursing homes nationwide. So what are some of the effective strategies you've seen to recruit and retain and support quality staff?

You know I'm a big fan of celebrations and that's more than a pizza party. Celebrating the tiny little successes, the things that are just over the top your resident successes. I, I believe a happy facility. One that humor's a huge part of  and the leaders in the facility are just that they're leaders to me to recruit, retain, and support.

All three of those, adjectives that you use there, or verbs or whatever they could be used as starts with an effective leadership. Now, one of the things that I have always, always talked about. Is  how universities need to look at long-term care as a specialty, you know, we've got pediatrics as a specialty.

You've got O-B-G-Y-N as a specialty. Even geriatrics is different than long-term care. In my opinion. There should be a specialty for long-term care that teaches from the very beginning. This is what it takes to be a skilled nursing facility or a long-term care. Professional and for long-term care to be taken out of that black sheep category and put into a category of its own specialty to where it is more than just a stepping stone.

And the opportunities for nurses and for other leaders at, I mean, most of the administrators I know have been social workers and activities directors, so  the opportunities for growth and enhancement in your career in long-term care is huge. If we would tout that as an industry, I think we would get more people seeing that working within long-term care is more than just, you know, they think putting on sweaters and playing chess or whatever.

 With residents we have to be so clinically. Competent within long-term care because we don't have hospitalists to call. We don't have respiratory to call. Usually we don't have the IV team to come in and do what they've got to do.  it's a very. Complex type of situation, and you have to be competent in your skills.

And another thing as far as staffing, we have to understand, and I can say this because I'm, of the older, I'm of the older team  gen. Nurses  that took care of residents back in the nineties, early nineties. And we have to know what the differences are as far as the workforce. We have to understand the generational gaps and what.

This new generation of workers look for, as opposed to what we looked for when we were younger and, just starting to work for. So those are some things I think facilities need to focus on in order to address the staffing shortages.  I would agree  with the newer generations. So shifting a little bit.

I'm fascinated with assisted living and the differences with long-term care, and I know that assisted living faces a different set of challenges compared to nursing homes. So what do you see as the top regulatory or care delivery issues in assisted living right now? Okay. I love assisted living too, and I'm just now getting to know them.

 I'm long-term care or skilled nursing from the go, but I am just in the past couple of three years learning assisted living and I love it. I love the passion that they have for their, residents. I love that, that, you know, they are, they're not afraid to try new things. They are not near as regulated.

As skilled nursing is, they only have state regulations, knock on wood.  I do feel like later on down the road that the federal regs will possibly creep into their world. But let's hope not.  that's one of the things that we at the Healthcare Association and the American Healthcare Association are really.

Fighting against making sure that the assisted living communities are regulated states instead of federal, but some of their, they're still regulated and they're still surveyed by OHFLAC in West Virginia. It's Tofl State Survey Agency.  And they still have. A list of, you know, the top 10 regulations that they are hit and miss on one, the very top one, and it's  I just had a conversation with Emily Jarvis, who is the head of the assisted living program with OHFLAC, and  she said.

That the number one regulatory issue within long-term or within assisted living that they found is med passes. So you've got how med passes are done, who does them, you've also have to have the RN who is the a, a map, which is the the acronym for the folks within the long-term care facil or within the assisted living facility.

And I apologize for continuing 'cause they are long-term care, but it's just. You know, to differentiate the two the aaps. I have to have certain  reviews. And she said that is one of the areas that a lot of facilities are having some issues with some med passes.  Another issue that they were talking about was the licensure.

There's a certain licensure they have to send in. And they want it done 90 days prior to the facilities licensure running out. And so that's kind of something I try to bring to everybody's attention. And then, you know, your two step PPDs  those are the top regulatory issues that they're seeing in the assisted living facilities now.

 It's really interesting to hear the contrast, you know, with Yes, it definitely is. It's it, and it's interesting to look at the difference in the regulations because federal regulations are 800 and some pages from nursing facilities, and I believe the state for assisted living is like 86, something like that.

I could be wrong, but I'm thinking that's what it is. Goodness. So if providers and administrators are trying to stay current, and I will say it is challenging to find reliable sources for education around regulatory guidance in long-term care. So where are the best and most reliable sources for up-to-date education?

place, I go to a lot. I always go to CMS itself. I always go to the QSOs, which are the memos that. CMS sends out and the Q Core site. Now, I would give you the acronyms, but I don't store those in my brain. I don't know what they mean, but they, you know, I know what they are.  Because if I, tried to remember all the acronyms, I'd forget where I lived.

  if you are in long-term care, you need to know. The CMS website and what they have and what they can offer. Our parent company, the American Healthcare Association, is a great resource. I go to them all the time, and of course, folks in West Virginia can always come to the West Virginia Healthcare Association.

 I assist people every day on questions they have. I have time to look up policies, I have access to other. Facilities they can, that I can touch base with and see what they're doing. And of course I've always used our QIO from the Quality Insights folks. They are so knowledgeable and so helpful, and we are just a team all the way around entire west.

That's one thing about West Virginia is we are one. Big team, and we work with OHFLAC, we work with the Ombudsman, we work with Quality Insights, we work with the Office of Epidemiology. All of these experts aren't afraid to work together, and that's such a wonderful option within our state.

Yeah, I agree. It's a, really wonderful environment in healthcare in West Virginia. It sure is. Yep. So can you share what the West Virginia Healthcare Association does to support long-term care providers and how your role as director of regulatory services fits into that mission? Sure can. We're a very small, healthcare Association. There's, five of us. And my role, I've been an RN in long-term care since 91, so I've done everything from head bottle washer to, you know, director of nursing all the way around the bend. Except administrator. I've not been the administrator.  but I've worked with the best.

  I provide a lot of the clinical guidance, a lot of the regulatory guidance.  people will call and they want an interpretation of a certain thing that's going on within their facility, and I help them a lot with that. Lots of times it's such gray areas. And facilities know there is no true answer.

And if you call and the ASCO flack, you know, it's, there's so many, if you have three people in a room, you're gonna have three different answers to that same question. So as far as support, they, and I always tell 'em, even if you wanna call and just. Bus, you're more than welcome to do so. call and let me, 'cause I know what's going on.

 now my, CEO is Marty Wright. And when I tell you he, but you can't let him know that I'm talking nice about him because he thinks I don't like him.  He is. On the legislative front, I never realized working in a facility for 20 years how important it was to keep up with what was going on with the legislation, with the regulatory issues within the legislative body.

I had, I mean, I knew we were governed by that stuff, but I did not know that the West Virginia Healthcare Association was out there fighting that good fight for the providers across the state and for the residents across the state.  I never knew it.   We have folks that, understand the laws, how it's interpreted, what's on the back end of those laws.  that right there is one of the most important things that the West Virginia Healthcare Association does is work. for your facility and for the beneficiaries to get the best care that they can possibly get, and for it to be a positive experience within the facilities.

Yeah, I think the West Virginia Healthcare Association is just, I mean, it's like the go-to if you have questions, and I mean, you make that possible, Marty makes that possible. And I'll just say you put on a, just a fantastic annual conference. And just the, I'll say it is the most  I've been to a lot of conferences.

I've been to a lot of long-term care conferences. There's something about your conference that is just so. I don't know. It's like a feeling of family celebration. I mean, it is a really, it's a fantastic place to be. So kudos. Thank you. And I, do consider everybody in long-term care considers each other family, you know, it's  they compete each other against each other as far as census and all of that goes.

But when it comes down to it, we've got each other's back and that's so important. Yeah. So are there any state specific regulations or systemic issues in West Virginia that make delivering high quality long-term care, particularly difficult or unique?  Yeah, the West Virginia State regulations are more specific than the federal.

Now, a while back, it was kind of like a  repeat. And it was a lot longer than it, it is now. But they went through and they took out all the stuff that was just a repeat of the federal regs. And now if you go to the OHFLAC website and you pull up the state regs it will give you the specifics.

 Just for the West Virginia State guidance. Some of the more specific items includes environmental. You know, there's a lot of specific things under the environmental section in West Virginia that are more specific than federal. There's some staffing guidance in there.

There's also resident rights.

We have a fantastic ombudsman program within our state that focus on residents and their rights within the facility, which is exactly what they're supposed to do, and they know. what is best for the residents within the facilities and they fight for that. So in our state, residents rights is a very big topic as it should be.

 If you're not familiar with the West Virginia regs, then that's, that would be a good place to start to look at where. There, there's some  issues and some changes, and there's definitely within the survey world, there are things within our state that they focus on, and that's something again, that the healthcare Association tries to do.

every other Tuesday we have a call and we go over the things that people are seeing within the facilities, like if they've just had survey. They'll send me a list of this is what they looked at. For example, one of the things that they looked at was storage under sinks, and they're looking at it all across the state because they don't want anything stored under the sink where there's water damage and

this one facility had, I think, COVID test stored under there. And it was a deficiency. It wasn't a very big deficiency, but it, was a deficiency which impacts your five star. So what the company did was they screwed, shut all the doors under the sinks to prevent that easy tag from not happening no matter what.

So we do that. Every other Tuesday is go over what are some of the regulatory issues that they're seeing across the state. We also have a call with OHFLAC. With Mary Agnes Argento, who is the program manager we have a call with her and Matt Keefer, and Kelly and Emily and they tell us what they're seeing.

As far as for example, CPR, there's been big issues across the state with CPR from people not knowing what their guidance is from their policies and procedures saying. We follow the American Heart Association guidance, but then nobody knows what that is. We go over what the surveyors tell us.

They're seeing also on those Tuesday calls. That is so very helpful. I mean, and if you are a facility listening and you didn't know those calls were going on, I mean  that's like your little cheat sheet for survey. Amen. Yep. Yeah, most definitely.  Last question, and I am really eager to hear your answer to this.

What is your vision for the future of long-term care in West Virginia and nationally, and where is the industry heading and what needs to happen to get to your best vision of long-term care?  I love long-term care. It is my passion. I love what I do and I love the people that do it with me.

And I want to see a industry where, it's not just, it's not, they didn't go there to die. They go there to live their lives and I unfortunately, I see a lot more regulatory issues because that's what a lot of people who've not. Worked in long term care or haven't worked in the actual facilities.

Those that make the regulations think make things better, but more paperwork, more all of those things are detrimental to actual patient care. I pray that somebody sees. That we need to focus more on the resident and what they want and what they need and what they would love to have, as opposed to so many tiny regulations and.

Double charting and double documentation and all of these things that take away from resident care. I am worried about the budget cuts and those kinds of things, but all that negative Nelly stuff out of the way, I truly believe that those in long-term care. Have a love for it and that we are heading in the direction of resident centered care all the way all the time.

And in order to get there, we have got to have those that are as just as passionate as you and I are on. Making sure that our residents get the care that they deserve. And it's gonna take a lot of work I always told my students when I was teaching we are highly regulated.

We are the highest regulated, depending on what study you look at.  did it to ourselves because we didn't put the resident on the forefront, but they're now. They are there now. And as long as we continue in that trajectory, we are gonna be successful. Yeah, and I love that motto.

I think that should maybe be somebody's motto, maybe the West Virginia Healthcare Association, resident centered care, all the way all the time. There you go. Yep. I love it, Pam. This was a really fun conversation. I enjoyed it. If people want to learn more about the West Virginia Healthcare Association, is that website www.wvhca.org?

Is that how they learn more? Yes, it is. It absolutely is. And on, there's my contact information. You can call me, text me, email me. I'm always there to help, always there to listen, and I appreciate quality insights so much for all that you guys have done for our state as well. Thank you and we appreciate you and I'm sure we'll talk again.

Pam, thank you again. 

Thank you for tuning in to Taking Healthcare by Storm: Industry Insights with Quality Insights Medical Director Dr. Jean Storm. We hope that you enjoyed this episode. If you found value in what you heard, please consider subscribing to our podcast on your favorite platform.

If you have any topics or guests you'd like to see on future episodes, you can reach out to us on our website. We would love to hear from you.

So, until next time, stay curious, stay compassionate, and keep taking healthcare by storm.