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Saturday, July 18, 2015

Construction items to be mindful of when construction or renovation is due for congregates.

13.10.324 Design and operating criteria for congregate senior housing.
(A) All provisions of Chapter 13.11 SCCC, Site, Architectural and Landscape Design Review, and SCCC 13.10.323 (residential site standards), shall be met. Additional requirements are as follows.

(B) Minimum Unit Size.
  1. (1)  Studio: 400 square feet.
  2. (2)  One-bedroom: 550 square feet.
  3. (3)  Two-bedroom: 700 square feet.
(C) Kitchen Facilities. Minimum kitchen facilities shall contain 10 cubic feet cabinet storage area, a small one-basin sink, a half-size refrigerator, and a two-burner stove.
emergency power source with automatic transfer switch to supply power to all critical areas of the home to include AC/Heat/Lighting emergency/bathrooms, bedrooms, telecommunications, fire alarms, etc. (natural gas, propane, diesel, no battery system. The size of the unit shall be according to the size of the home and the
the house shall be fire sprinklered per life and safety code regulations which can be indwelling in the ceiling wall or exposed ceiling placements, risers shall not be obstructed or misused causing areas not to be sprayed with water should there be a fire. 8
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nurse call system, at each patient bed, wired into the central system with the bathroom pull tabs - no minimum requirement for type or brand
where semi-private rooms are used, privacy is provided by a pull curtain and rail system / fire retardant material is used for curtains seperating patients
paint used in the house should be a non-lead based paint and be washable to the surface with soap and water being the disinfectant
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Amenities.
(1) Adequate organized physical activity or social activities must be provided. Activity program shall be reviewed by the Seniors Commission and approved by the Human Resources Agency.
  1. (2)  Easy access shall be provided to outdoor recreational areas.
  2. (3)  Adequate programs shall be established for the delivery of
personal services such as maid and linen services, sundries, beautician and/or barber, banking, and other similar services. These programs shall be approved by the Planning Department.
  1. (4)  Signing. To be consistent with SCCC 13.10.580.
  2. (5)  Security.
(a) Peep holes in doors.
(8) Meals. Minimum two hot meals per day shall be provided.
(9) Special Services.
(a) A combination of interior and exterior areas and rooms of suitable size to accommodate the majority of the residents
(b) A covered or enclosed pedestrian access shall be provided from all residential buildings to the dining and recreation buildings. A covered walkway shall also be included
(c) All entrances and exits shall be wheelchair accessible.
(10) All services, requirements, financial arrangements, amenities, and other features of the facility must be disclosed
  1. (11)  Only one water meter shall be permitted per site.
  2. (12)  All projects shall be compatible with surrounding land
  3. (13)  All projects shall be consistent with California
  4. (14)  All facilities shall be reviewed by the Planning
Carpet should not be used as it does not flow smoothly with Where feasible, it is truly wise to use chair-railing in the patient rooms to cut down on the holes from the speciality beds, they can cause a lot of patch work. hpaltliwenatysroleoamdidnogotrowpaaytsiesnhtarlloboem3s6o"rvaeresausththeepsataienndtasrrdedsiodoerloikfea residential home at 33" (this includes doorways leading to the outside of the patient room to the outside of the home
fire alarm pull tabs should be used and main doors to the outside.

hallways should have path lighting for night time use
where it mentions the planning department in the above standards, these are exempt for facilities with <6 beds. Beds 7 and > must comply with planning department which is also known as OSHPD.
2500 sq b
1 pa_ent
2 pa_ents
3 pa_ents

handrail in restroom
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nonskid surfaces floors and tubs
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emergency pull tab in restroom and shower area & handrails too
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handrails in hallways
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contract with transporta_on medical service
free bus passes
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the emergency power supply shall be included in the fourplexes of the outlets. no unplugging and replugging in the event of failures. each bedroom shall have 1 -fourplex on each of the four walls.

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Sunday, July 12, 2015

Our list of in-network providers continues to increase. Month to date, here is our list of currently active in-networkable third party payers.


Aetna — HMO/PPO (CA/NV/AZ/CO)
Amerigroup — Managed Medicaid (NV)
Anthem Blue Cross/ Blue Shield — HMO/PPO (NV/AZ/CO) 

Arizona Foundation for Medical Care — PPO
Arizona SCF/Copper Mountain Mutual — WC
Beech Street Corporation — PPO (CA/NV)
Blue Cross of CA — HMO/PPO/WC
Blue Shield of CA — HMO/PPO
BlueCross Blue Shield of Arizona — HMO/PPO
Canon Cochran Medical — WC (CA)
Care1st — HMO/MediCal (CA)
CSAC — WC (CA)
Cigna — HMO/PPO (CA/NV/AZ/CO)

NV - Uses Managed Care Consultants contract 
ClarisPointe — PPO (CA/NV)
Compmed — PPO (CA/NV)
Corvel — WC/PPO (CA/NV/AZ/CO)

Coventry — WC/PPO (CA/NV/AZ/CO) 
Culinary Health Fund — PPO (NV) 
First Health — WC (CA/NV/AZ/CO) 
Focus — WC (CA/NV/AZ)
Fortified Provider Network — PPO (CA/NV) 
Galaxy Health Network — PPO (CA/NV)
Global Excel — TPA (Travel Insurance)
Great West Healthcare (Now owned by Cigna) —

HMO/PPO (CA/NV)
Gregory B. Bragg & Assoc. — WC (CA) 

HealthNet — HMO/PPO (CA/NV)
Health Management Network — PPO (AZ) 

Health Plan of Nevada — HMO (NV)
Heritage Health Plan — HMO (CA)
Hines — PPO (National)
Independent Medical Systems — PPO (CA/NV)

 Injury Care — WC (CA/NV)
Integrated Health Plan — PPO (CA/NV)
Interplan — PPO (CA/NV)
Kaiser — (CO/LA County, CA)
Legacy Provider Network — WC (NV)
Managed Care Consultants — (Cigna NV) - 

HMO/PPO Midwest Employers Casualty —WC
Memorial Healthcare — HMO (CA)
Multiplan Inc. — PPO (CA/NV)
National Provider Network (NPN) — PPO (CA)
Networks By Design — PPO (CA)
Nevada Medicaid — (NV Pediatrics only)
Nevada Preferred Health Plan — (NV)
One Call Care Management (OCCM)— 

WC (CA/NV/AZ/CO) 
Orange County PPO Foundation — PPO (CA)
Paradigm — WC (CA/NV/AZ/CO)
Pinnacol Assurance — WC (CO)
Prime Health Services — WC/PPO (National)
Private Healthcare Systems (PHCS) — PPO (CA/NV) 

Prospect Medical Group — Managed Medicare (CA)
Regal Medical Group — HMO (CA)
Regional Centers of Orange County
Regional Centers of Tri Counties
Regional Centers - Alta
Saint Mary’s Health Plan — HMO (NV)
SCIF (State Compensation Insurance Fund CA) —
 
WC Sierra Health Services — HMO/PPO/WC/Medicare (NV) 
Teachers Health Trust — PPO (NV)
Three Rivers Provider Network — PPO (CA/NV)
United Healthcare — PPO/HMO (CA)
Universal Health Network — PPO (CA/NV)
Veterans Affairs (VA) — VISN 21 (CA), VISN 18 (PHX),

VISN 22 (Long Beach) YORK — CA (WC) 

State Legislation has been introduced to allow for a total of 18 beds versus the 12 that is in current law for California.

Around the 11th of July, 2015, state legislation was introduced to approve the number of licensed beds from 12 to 18 according to an article released by the State Capital that can be seen here.

We throw a reminder out to you to keep in mind and be thoughtful of the problem with doing a 12 or 18 bed facility has nothing to do with anything more than the additional regulations.  With 12 or 18 beds, the congregate facility would still need to seek to obtain OSHPD acceptance and approval for the facility.  OSHPD typically runs anywhere between 1-3 years to get plans approved for a new facility.  This on top of the fact that the state office of licensing and certification takes another 1.5-2 years for the issuance of the license, this goes to place the first real start up time to increase to three years from start to finish, a completely unrealistic expectation for any owner.  

The bill proposed was introduced  by a corporate sponsor, which would go to allow them increase their number of licensed beds to 18 for those facilities that have 12 currently.  So, the bill is being sponsored to increase their shares in the market herein.  The corporate entity is Care Meridian, the biggest competitor to the Southern California market of Congregate facilities.  

The bill introduced provides that:


Summary
This bill adjusts the requirements affecting licensed Congregate Living Health Facilities (CLHFs) to increase the number of allowed beds from 12 to 18 beds.
Background
CLHFs are required to provide a non­institutional, home­like environment, while providing medical care that is generally less intense than that provided in general acute care hospitals, but more intense than that provided in skilled nursing facilities. CLHFs are licensed to provide services to one of three types of persons: persons who are mentally alert but have physical disabilities and may be ventilator­ dependent; persons who have a diagnosis of terminal illness or a life­threatening illness, as defined; or persons who are catastrophically and severely disabled, as defined.
Problem
CLHFs provide critical services for patients who are deemed sufficiently stable to no longer meet criteria for an acute hospital stay but are too medically fragile to go a skilled nursing facility or directly home.
Presently, CLHFs not operated by a city or county are limited to a maximum of 12 beds; however, CLHFs operated by a city or county can be licensed up to a capacity of 59 beds.
Patient and family demand for alternative, non­institutional settings is increasing. As required by law, CLHFs provide a home­like setting for patients who meet licensed criteria. CLHFs also provide younger, non­geriatric patients an age­appropriate alternative to a skilled nursing facility.
Presently, demand for CLHF services is increasing beyond the current capacity and the only alternative to expanding the number of beds permitted from 12 to 18 is for operators to construct new CLHFs in the same community. New and unnecessary construction lengthens the time it takes to place patients who need care in a CLHF, and adds to the number of facilities that the Department of Public Health (DPH) would have to oversee.  Further, as healthcare inflation continues its upward climb, providers must look for ways to lower the cost of patient care. By increasing the number of licensed beds from 12 to 18, providers may reduce the fixed costs related to operating a CLHF, rather than increasing costs due to new construction, etc. to meet patient demand.
Solution
Increase the maximum number of beds from 12 to 18.
This does not diminish the residential, home­like feeling of the CLHF but it does offer the following:
Better economies of scale as fixed costs can be spread among a larger patient population, and therefore reduced cost to patients. Increased access to appropriate and necessary care.
Reduced burden on the state to oversee additional CLHF facilities to meet same demand
Greater parity between the restrictions placed upon private and public sector CLHF licensed programs. 

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