By Dave Ranney
KHI News Service
TOPEKA
Those in the front office at the Kansas Department on Aging say they”re all for “resident-centered” care.
But nursing home administrators say the department”s regulations often discourage innovation.
“We have some hurdles to work through,” said Debra Zehr, president at the Kansas Association of Homes and Services for the Aging, an organization that represents nonprofit nursing homes.
Take, for example, sinks.
The regulations say a nursing home”s activity room must have at least one sink for hand-washing.
At The Cedars nursing home in McPherson, the activity room also is the living room. So to comply with the regulations, The Cedars had to install a sink in the living room.
By itself, the sink is not a big deal. But as part of “resident-centered” care, nursing homes
try to create smaller, more home-like spaces.
A sink in the living room is hardly home-like, administrators said.
“I understand the need for a hand-washing sink,” said Carla Lehman, administrator at The Cedars and a leader in the state”s resident-centered care movement.
“But our bedrooms are no more than 15 feet away from the kitchen, and each bedroom has a bathroom,” Lehman said. “We thought those sinks could be counted as a hand-washing sink.”
They were not.
The Cedars also had to install two sets of smoke-barrier doors.
“The assumption is that if there”s a fire, we can take residents to the other side of the building,” Lehman said. “But if there”s a fire, we”re not going to stay in the building, we”re going to take them next door. There”s no provision in the life-safety code for that.”
The facility next door is about 30 feet away.
Crossing swords
In Olathe, the Department on Aging made the Evangelical Lutheran Good Samaritan Society hire a full-time certified dietary manager before it could open Hoeger House, a 17-bed, state-of-the-art nursing home.
“We”re right next door to a 140-bed Good Sam (Good Samaritan nursing home) facility, and we”d planned on using their dietitian, but the state said no,” said Hoeger House administrator Rachel Storm.
“I don”t know how we”ll keep her busy with just 17 residents,” she said. Usually, one certified dietary manager handles about 70 residents.
Regulations require at least one certified dietary manager per facility and Hoeger House is considered a separate facility.
Storm and Lehman said most administrators resist crossing swords with the department”s regulators. No one, they said, wants to seen as troublemakers.
“By themselves, the regulations aren”t all that bad it”s the way they”re interpreted that keeps providers pretty confused,” Lehman said. “You can have one surveyor tell you something”s OK only to have the next one tell you it”s not.”
Being found out of compliance can and often does lead to citations, fines, penalties and bad publicity.
Department on Aging Secretary Kathy Greenlee is well-aware of the problem.
“This is one of if not the most immediate issues we”re dealing with as an agency,” she said.
Earlier this fall, Greenlee met with several nursing home administrators who have adopted resident-centered care.
“I want feedback,” she said. “I want to hear from people who can say “We”ve done it and here”s where the problems are,” and I want to hear from people who can tell us how to move forward.
“We do not want to be in the way of resident-centered care,” Greenlee said.
It won”t be easy. Many of the regulations have been decades in the making and, in some cases, are backed by federal mandates.
“I can never give away regulations that have a basis in quality of care we can”t let go of quality of care as we move forward,” Greenlee said. “But I”m very open to figuring out how we can be supportive as regulators.”
The state”s nursing home administrators need to be “open” as well, she said.
“We need more administrators to step up and show leadership,” Greenlee said. “These changes are going to be difficult, time consuming and a multi-year project. They”re not something we can do overnight.”
Broken systems
Steve Shields, president and CEO at Meadowlark Hills, a Manhattan retirement community, is a nationally recognized leader in the resident-centered care movement. He said nursing homes should not lose sight of why they”re so closely scrutinized.
“We”ve been doing what we do in an unacceptable way for decades,” Shields said. “Consequently, an unacceptable response system has built up around it. Both systems are broken.”
Dave Ranney is a staff writer for KHI News Service, which specializes in coverage of health issues facing Kansans. He can be reached at
dranney@khi.org
or at 785-233-5443, ext. 128.