OHCA The Oregon Caregiver Spring Summer 2024

A Publication of the Spring/Summer 2024 Oregon Health Care Association OHCA Policy Priorities | Q&A with Sen. Weber | Resident Choice and IBLs Embracing Resident Preferences

SPRING/SUMMER 2024 © 2024. The contents of this publication may not be reproduced or distributed electronically or mechanically, either in whole or in part, without the express written consent of the Oregon Health Care Association. The advertisers assume complete responsibility to use any or all brand names, trademarks, guarantees, and statements which appear in their advertisements. CONTENTS FEATURE 21 18 24 pg6 Embrace and Adapt: How HCBS is Reshaping Long Term Care In this article, we profile various leaders from facilities across Oregon who are embracing and exemplifying HCBS values, providing insight into how they ensure resident preferences are acknowledged. 04 LETTER FROM THE CEO 06 EMBRACE AND ADAPT: HOW HCBS IS RESHAPING LONG TERM CARE 11 DATA & RESEARCH The Use of Home and Community-Based Services: Where Are We Now? 12 QUALITY Learn More About the National Quality Award Program 14 LEGAL & REGULATORY Supporting Resident Choice with Individually Based Limitations 15 PUBLIC POLICY Resident Experience Drives Policy Priorities 16 SPONSORED CONTENT Embracing Diversity in the Dining Room Journey to Community-Based Care Nursing: Caring for Residents as Whole People 20 PROFILES Corissa Neufeldt (Safety and Regulatory Deputy Director, Oregon Department of Human Services (ODHS)) Senator Suzanne Weber (R-District 16) 24 2024 SPRING EXPO 28 UPCOMING EVENTS

The Oregon Caregiver SPRING/SUMMER 2024 www.ohca.com 4 Our focus in this issue of The Oregon Caregiver is to put a spotlight on the tireless work that providers around the state do every day in order to fulfill the requests and preferences of their residents. The implementation of home and community-based services (HCBS) has encouraged and challenged providers to tailor their care plans more closely to the individual needs of their residents. Through interviews with providers and leaders from across the state, we find out the specific ways these caregivers and facilities are embracing their resident’s preferences. Needing care does not negate an individual’s right to preference or disregard their freedom of choice. From meal planning to activity directing to meeting residents’ communication needs, this issue highlights the creative strategies and invaluable work these providers do daily to meet the highly important and ever-changing needs of their residents. In our feature article, we profile caregivers from across the state who have embraced the HCBS rules and regulations. These providers give insight into the positive outcomes, opportunities, and challenges that come with the implementation of HCBS. In our quality article, Nicolette Reilly highlights the AHCA/NCAL Quality Award Program, encouraging providers to evaluate their strengths, opportunities, and areas for improvement through this comprehensive performance assessment. OHCA general counsel Eugenia Liu provides a detailed explanation of Individually Based Limitations (IBLs), an integral facet of HCBS guidelines. Libby Batlan reviews what the government relations team accomplished during the 2024 short session and provides a glimpse into the goals for the 2025 session. Walt Dawson shares valuable data that provides insight into the benefits of HCBS implementation. Two OHCA business partners share how their work enhances the specific needs of Oregonians living in long term care. In our policymaker profile, Senator Suzanne Weber discusses her passions and legislative priorities. Corissa Neufeldt of the Office of Aging and People with Disabilities provides insight into how HCBS impacts care at the state level in our leader profile. Review highlights from the 2024 OHCA Spring Expo in Salem and save the dates of important in-person and online events and trainings coming up this summer. You can read this magazine and all past editions of The Oregon Caregiver on our website, www.ohca.com.  Choosing Choice: Embracing Resident Preferences Daily 11740 SW 68th Pkwy, Ste 250, Portland, OR 97223 Phone: (503) 726-5260 www.ohca.com OHCA STAFF Libby Batlan • Senior VP of Government Relations Philip Bentley, JD • President & CEO James A. Carlson • Advisor Mary Dakin • Workforce Development Manager Cheryl Durant • CRM Administrator/Accountant Melodie King, CMP • Director of Education Eugenia Liu • Senior VP & General Counsel Brenda Michael • Assistant Controller Lori Mueller • CFO Nicolette Reilly • Senior VP Quality Services Maggie Walter • Communications Coordinator Rosie Ward • Senior VP of Strategy BOARD OF DIRECTORS CHAIR Steve Fogg, Marquis Companies, Inc. IMMEDIATE PAST CHAIR Kathy LeVee, Generations, LLC VICE CHAIR Mark Remley, Aidan Health Services, Inc. TREASURER Andy Becker, Sapphire Health Services NON-PROPRIETARY REPRESENTATIVE JoAnn Vance, Providence Child Center MULTI-FACILITY REPRESENTATIVE Ryan Delamarter, Prestige Care, Inc. MULTI-FACILITY REPRESENTATIVE Rick Dillon, Avamere Health Services BUSINESS PARTNER MEMBER REPRESENTATIVE Gabriela Sanchez, Lane Powell, LLC ALF REPRESENTATIVE Mauro Hernandez, PhD, Hearth & Truss; ITA Partners, LLC INDEPENDENT NURSING FACILITY REPRESENTATIVE Kelly Odegaard, Westcare Management BUSINESS PARTNER MEMBER REPRESENTATIVE Marcy Boyd, Moss Adams, LLP AT LARGE REPRESENTATIVE Brenda Connelly, The Springs Living IN-HOME/SENIOR HOUSING REPRESENTATIVE Jonathan Mack, Home Instead Senior Care of Central Oregon RCF REPRESENTATIVE Mark Kinkade, Gateway/McKenzie Living ALF/RCF REPRESENTATIVE Lisa Maynard, The Springs Living ALF/RCF REPRESENTATIVE Matt Hilty, Ohana Ventures OC EDITORS Maggie Walter • [email protected] Rosie Ward • [email protected] OC PUBLISHER LLM Publications • www.llmpubs.com Advertising Sales • Ronnie Jacko (503) 445-2234 • [email protected] Design & Layout • Shelby Bigelow Phil Bentley President and CEO Oregon Health Care Association LETTER FROM THE CEO Stay connected with OHCA! Contact Maggie Walter, [email protected], to be added to our email lists.  Improving lives by advancing quality care in Oregon since 1950

The Oregon Caregiver SPRING/SUMMER 2024 www.ohca.com 6 FEATURE EMBRACE AND ADAPT: HOW HCBS IS RESHAPING LONG TERM CARE By Maggie Walter, Oregon Health Care Association Avamere at Chestnut Lane is the only assisted living facility specializing in serving residents who are Deaf and Deafblind in the western United States.

www.ohca.com SPRING/SUMMER 2024 The Oregon Caregiver 7 FEATURE Home and community-based services (HCBS) are a set of rules and regulations that ensures individuals choosing to receive care within their homes or within a community have the same rights as they would if they were not receiving care. Dawn Pratt is the chief operations officer of Caring Places Management. However, HCBS is more than just rules to be followed, it is a mindset shift. HCBS is person-centered care that emphasizes the idea that individuals receiving care are more than just their diagnosis: they are complex people with unique histories, passions, dislikes, and desires. Freedom of choice is one of the most basic of human rights, and HCBS embraces it. The implementation and encouragement of HCBS training in long term care has brought this concept to the forefront in the minds of caregivers and all long term care staff statewide. Across Oregon, the implementation of HCBS training is encouraging care providers to re-evaluate various aspects of resident care plans. Whether that inc- ludes adjusting communication preferences, curating highly-individualized activity schedules, or updating their menus to suit individual residents’ tastes, facilities statewide are viewing HCBS rules as an opportunity, not a roadblock. In this article, Billie Wingfield, Michele Nixon, Dawn Pratt, and the staff at Avamere at Chestnut Lane provide a few examples of how caregivers in Oregon have welcomed HCBS, incorporating it in every aspect of a resident’s daily life. Some Ways Providers Are Embracing Resident Preferences When it comes to activities, Dawn Pratt, chief operations officer of Caring Places Management, believes that activities must provide purpose, pleasure, or peace. Clearly, these are subjective terms that are not one-size-fits-all. Especially in a memory care setting, it is incredibly important for residents to engage in activities that give them a purpose and help to dispel anxious behaviors. Pratt believes in the power of individualized activities, allowing residents at different levels and with different interests to feel catered to and fulfilled. In one of Pratt’s facilities, staff heavily utilize “life skills stations:” work- environment simulations that reflect the real jobs of the residents. There could be grocery store settings, offices, nurseries, etc.; you name it and the staff would accommodate it. Pratt recalls one resident who was a postal worker for her entire career: “Every single day, this woman would say ‘I need to go to work,’ which is very common in a memory care community. So, the staff put together a life skills station for her with a time clock so she could clock in; USPS signage; and a table with envelopes, stamps, and packages,” said Pratt. “She would spend the day delivering packages and mail to other residents, and it kept her busy, engaged, and feeling satisfied. She was still working and fulfilling what she felt like was her purpose.” This was all just based on one woman’s job, the staff realizing that she would not feel pleasure or purpose from ‘working’ a job she had no connection with. At Caring Places facilities, Pratt says this attitude and embracement of individual resident preferences is just a way of life. “We have always built our facilities around resident preferences and the CONTINUES » individual resident. We create one-onone individual activities plans. Our activities calendars are updated monthly, and they are everchanging with what the current interests are, not what the interests were five years ago, or even six “Every single day, this woman would say ‘I need to go to work,’ which is very common in a memory care community. So, the staff put together a life skills station for her with a time clock so she could clock in; USPS signage; and a table with envelopes, stamps, and packages, She would spend the day delivering packages and mail to other residents, and it kept her busy, engaged, and feeling satisfied.” – Dawn Pratt, Caring Places Management

The Oregon Caregiver SPRING/SUMMER 2024 www.ohca.com 8 FEATURE » FEATURE, CONT. months ago.” This individualized approach to activity directing exemplifies HCBS, ensuring that residents feel seen and valued by their caregivers and community. Avamere at Chestnut Lane is the only assisted living facility specializing in serving residents who are Deaf and Deafblind in the western United States. “Our residents have shared they appreciate having the ability to communicate through American Sign Language (ASL). This creates a sense of belonging and community. Our senior living team is also able to explain information and medications from doctors, so residents can have full understanding of their healthcare needs,” says a staff member at Chestnut Lane. Meeting residents’ communication preferences is an integral part of making sure residents’ needs are met and that their preferences are acknowledged. “Our team members have shared that they feel safe and understood here, and that help is being provided to residents in the way that it should be,” they explain. “This cultivates a family environment, where every team member and resident can feel valued and that they belong.” The foundation of the connections between residents and staff comes down to communication. Supporting Resident Choice Avamere at Chestnut Lane believes in the power of resident autonomy, allowing residents to feel independent while continuing to offer the services necessary to ensure resident safety and wellbeing. “We provide transportation for errands and outings, and can assist residents with ordering transportation as needed. We are also conveniently located next to a train station, allowing residents the freedom to go on their own outings,” explained the staff. Allowing this autonomy gives residents a sense of agency they may have felt was missing living elsewhere. Wherever a resident needs to go, staff at Chestnut Lane will make sure it is possible. Additionally, resident engagement is of the utmost importance at Chestnut Lane. “We have various monthly meetings dedicated to seeking resident input, including our Resident Council where residents share their feedback, Chef Corner where we welcome input on our menu options, and activity meetings to choose upcoming activities,” said a staff member. Michele Nixon, senior regional director of operations for Senior Housing Long term care communities use a resident’s history and personal preferences to create unique, person-centered activities and care plans.

www.ohca.com SPRING/SUMMER 2024 The Oregon Caregiver 9 FEATURE Managers, LLC, believes in the value of smaller facilities in being able to accommodate the needs of all residents. Nixon states, “We are a fifteen-bed facility, so we can provide 24-hour care for our residents as they are up throughout the night. If a resident wants breakfast at 11:00 a.m., they will get breakfast at that time. If a resident wants dinner at 11:00 p.m., they will get dinner at that time.” She continues, “We can provide that personalization for our residents because we are small and can accommodate them and their choices.” Incorporating a Resident’s History Not all residents may be able to communicate their needs and preferences clearly. In memory care facilities, it is incredibly important to lean on the residents’ families for insight into their likes and dislikes, their employment history, what hobbies they have, and their personality traits. Billie Wingfield, vice president of management services at Senior Housing Managers, explains just how vital this discovery process is in working with residents with dementia. “We embrace each resident and their differences. We do a great job of that through our evaluations and assessments before they even get into the building. We utilize an actual activity assessment tool so that we can deeply learn about our residents and develop a ‘My Story’ for each person, going beyond just what they like to do, but finding out who they were prior to their diagnosis,” she says. “Since we work primarily with folks who have dementia, it can be challenging to know who they were and what they did, so we lean heavily on families and our assessment tools to deep dive and do some discovery.” Through this discovery process, a resident’s diagnosis becomes only a small part of their story, not their entire narrative: an important facet of person-centered care. Through leaning on families to help create individualized activities for residents, Pratt at Caring Places recalls how embracing resident preferences led CONTINUES » Michele Nixon and Billie Wingfield work together at Senior Housing Managers and have dedicated their careers to long term care. “If a resident wants breakfast at 11:00 a.m., they will get breakfast at that time. If a resident wants dinner at 11:00 p.m., they will get dinner at that time. We can provide that personalization for our residents because we are small and can accommodate them and their choices.” – Michele Nixon, Senior Housing Managers

The Oregon Caregiver SPRING/SUMMER 2024 www.ohca.com 10 FEATURE to improving a resident’s physical state just as much as their mental state. At one of Caring Places’ memory care facilities, staff implemented a program called “Rain Music” for residents. Each resident had their own iPod, set up with a family-curated, personalized playlist of all their favorite songs. “We had one resident… and she came into the community very contracted, very turned into herself,” Pratt remembers. “She could not wheel her own wheelchair, and she was nonverbal. So, we put together an iPod for her based off the songs that her family said she really loved, and she started talking! She started talking about her college days, she would state her preferences, and she even began wheeling her own wheelchair around!” The personalized playlists created by the resident’s family led to a full transformation of the resident’s state of being, exemplifying the importance of incorporating each resident’s personal history into activity planning. From individual assessment tools to leaning on resident’s families for a glimpse into their past, facilities across the state are finding different ways to guarantee that each resident will feel represented in their activity planning. HCBS Impact on Staff It is no secret that with the pandemic came many staffing challenges within the long term care industry. Along with staffing challenges, the pandemic altered resident preferences. Many residents now choose to take their meals in their rooms instead of in the dining room, a habit that started because of COVID-19 regulations but has stuck years later. “I noticed that even after things were opening up, residents were used to being in their rooms, they’re used to being alone, and they didn’t want to come outside for activities or to eat,” Pratt said. “We had to work hard to find out what will interest them to come out, while at the same time accommodating their preferences.” Despite these hurdles, Wingfield of Senior Housing Managers reflects on the benefits that have come from the implementation of HCBS into her facilities. “It has made positive changes. We are now dialing in even more now to the individual and what their capabilities are, and not just using the broad term of ‘dementia’ to describe everyone, because they each had full lives before us,” she said. “I think it has really challenged us to look at residents through a better lens and really focus on what they are capable of.” Wingfield goes on to explain how these rules have created a mindset shift of the staff within these memory care communities. She said, “HCBS has gotten us in the habit of saying, ‘How can we accomplish this request?’ instead of saying, ‘Oh, no, we don’t do that here,’ or, ‘That’s never going to work.’ We are sitting down and finding how we can make things happen, even in a memory care environment, for any individual who can manage it.”  » FEATURE, CONT. “HCBS has gotten us in the habit of saying, ‘How can we accomplish this request?’ instead of saying, ‘Oh, no, we don’t do that here,’ or, ‘That’s never going to work.’ We are sitting down and finding how we can make things happen, even in a memory care environment, for any individual who can manage it.” – Billie Wingfield, Senior Housing Managers

www.ohca.com SPRING/SUMMER 2024 The Oregon Caregiver 11 DATA & RESEARCH Home and community-based services (HCBS) are increasingly utilized across the states to provide long term services and supports (LTSS) to older adults and people living with disabilities. This nationwide increase is driven by a focus on improved access to multiple care settings, along with a desire to move away from more costly nursing facility-based care when other care settings are more appropriate. To accomplish this aim, HCBS are often provided through the Medicaid program, which pays for care provided in community-based settings such as assisted living and memory care communities or in a person’s own home, such as working with an in-home care agency or by paying a family member, neighbor, or friend to provide assistance. Since 2013, more Medicaid dollars have been spent on HCBS per year than on nursing facility-based care. According to a 2023 report from the Kaiser Family Foundation, by 2020 (the most recent year that comprehensive data is available), 72% of all Medicaid LTSS enrollees solely used HCBS for their LTSS needs, 4% used both HCBS and institutional care, while 24% received care and support in nursing facilities. During the COVID-19 pandemic, the American Rescue Plan provided additional funding for states to provide HCBS. These data points demonstrate just how important and widespread the use of HCBS have become over the past few decades. Oregon in particular has a long and storied history of using HCBS to provide LTSS. The first Medicaid Waiver to pay for care in settings other than nursing facilities was granted to Oregon in 1981. This allowed for care to be provided in a home-like environment. Today, all states have some type of HCBS Waiver in place. But the extent of the services offered through these waivers as well as the number of waivers in place varies by state. Building on the early innovations in care, Oregon continues to be a national leader in the use of HCBS today. As much as 95% of Oregon’s entire LTSS population receives those services and supports via HCBS. According to an analysis from Mathematica of Federal Fiscal Year 2020 Medicaid expenditures, nearly 84% of all Oregon Medicaid dollars are spent on HCBS annually, which is the highest rate of any state in the country. This high utilization of HCBS ensures that all Oregonians in need of care and support have the option to receive those services in the settings which will best meet their unique needs with dignity, honor, and respect. There are several types of waivers that states can obtain from the Centers for Medicare & Medicaid Services (CMS) to offer Medicaid funded long term care services. Oregon currently has multiple approved waivers in place including a 1915(c), 1915(b)(4), and 1115 Demonstration Waiver, along with innovative Medicaid state plans such as the so-called K Plan which provides an enhanced 6% federal rate to Oregon for The Use of Home and CommunityBased Services: Where Are We Now? By Walt Dawson, D. Phil providing expanded HCBS. The use of multiple waivers along with state plans allows for continued innovation and expanded access to Medicaid services. Oregon continues to innovate with the use of HCBS. Late last year, Oregon’s longstanding program to support non-Medicaid individuals in need of long term care services, Oregon Project Independence (OPI), received approval for expansion as part of a Medicaid 1115 Demonstration Waiver. This waiver allows for Medicaid funds to be used to support OPI participants for the first time in the history of OPI. The continued uptake and enhancement of HCBS across the country is an important evolution of the LTSS system in the United States. HCBS are fundamental to Oregon’s innovative LTSS system. Oregon must continue to be a leader in HCBS in the years ahead, as new opportunities to support the LTSS needs of older adults and people living with disabilities become clearer. Additional information about Oregon’s HCBS Waivers and associated rules can be found online.  Walt Dawson is OHCA’s research consultant as well as an assistant professor at Oregon Health & Science University and a senior Atlantic fellow with the Global Brain Health Institute. Building on the early innovations in care, Oregon continues to be a national leader in the use of HCBS today. As much as 95% of Oregon’s entire LTSS population receives those services and supports via HCBS.

The Oregon Caregiver SPRING/SUMMER 2024 www.ohca.com 12 Learn More About the National Quality Award Program By Nicolette Reilly, Oregon Health Care Association The AHCA/NCAL National Quality Award program recognizes long term care providers for their commitment to and achievements in quality improvement. The award journey creates a foundation that builds and sustains improvement in critical areas such as workforce, operations, leadership, and strategic planning. It encourages providers to evaluate their organizations’ strengths and opportunities; identify critical areas for improvement; and implement a plan to be stronger, more resilient, and more successful than ever before. The threetiered program evaluates long term care providers’ capabilities against nationally recognized standards for excellence, making it one of the most comprehensive active performance assessments available to providers. Each progressive award level—bronze (commitment to quality), silver (achievement in quality), and gold (excellence in quality)—requires a more detailed demonstration of superior performance. The bronze award level provides applicants with the tools and resources needed for continuous improvement in quality care. Through the bronze criteria, based on the Baldrige Excellence Framework, applicants assess their organization’s mission, vision, and key factors that lead to success. At this award level, utilizing the criteria questions, applicants develop an organizational profile for their center. This level supports the building of strong foundations to grow and advance quality in the facility. At the silver award level, applicants continue to learn and develop effective approaches that help improve performance and health care outcomes. The silver criteria provides applicants with a thorough assessment of how their organization works, its effectiveness, and tools for improvement in their approaches. At the gold award level, applicants must show superior performance in areas including leadership, strategic planning, and customer and staff satisfaction. By completing the gold level criteria, organizations take their quality journey to a higher level through the valuable feedback received in the application process and thereby reaching organizational goals. Gold applicants address the Baldrige Excellence Framework in its entirety. To maintain active recipient status, recipients have three years from the year the facility received the award to advance to the next level or reapply for the current level. OHCA encourages all member facilities to apply for this program each year as a part of their quality journey and commitment to continuous improvement. Please visit this link to learn more: https://www.ahcancal.org/Quality.  Nicolette Reilly is the SVP of Quality at OHCA. QUALITY

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The Oregon Caregiver SPRING/SUMMER 2024 www.ohca.com 14 LEGAL & REGULATORY Supporting Resident Choice with Individually Based Limitations By Eugenia Liu, J.D., Oregon Health Care Association We often leap to the conclusion that “limits” are a negative thing. However, limits could have positive connotations. In fact, individually based limitations, also known as an “IBL,” are a tool that can be used to support a resident’s rights, preferences, and choices as well as promote their health and safety. What Is an Individually Based Limitation? An IBL is a person-centered tool that is used to mitigate a risk and support a specific need in connection with the federal home and community-based settings (HCBS) rules. IBLs are not the same as a risk agreement and they can only be used in community-based care settings. IBL requirements are outlined under OAR 411-004-0040. IBLs cannot be unilaterally implemented by a facility. IBLs must be supported by a specific assessed need and be: (1) necessary to protect the health and safety of the resident or others; and (2) accepted by the resident for whom the limitation is needed. Facilities need to follow strict documentation requirements to implement an IBL. Some of the key elements that must be identified and documented include: • The specific and individualized assessed need that justifies the IBL • The positive interventions and supports that the facility attempted prior to turning to an IBL • The less intrusive approaches that have been tried but did not work • The established time limits for periodic review of the IBL, which must occur at least annually if not more frequently, to determine if the IBL is still needed or can be terminated • An assurance that the IBL does not cause harm to the resident The facility must secure the informed consent of the resident and/or their legal representative and note any discrepancies between the wishes of the resident and the consent of the resident’s legal representative. The facility also needs to complete the appropriate forms and have the resident, or the resident’s legal representative, sign the forms before implementing the IBL. Consent for an IBL must be informed. This means the resident and/or their legal representative is fully advised of the benefits, risks, and alternatives of the particular course of action or limitation. The discussion of risks and benefits may involve other interdisciplinary team members, such as the resident’s physician or other relevant third-party providers. When Can Individually Based Limitations Be Used? There are many ways that an IBL can be used to enhance resident choice, health, and safety. For example, a diabetic resident may have difficulties managing their blood sugar levels and their physician recommends limiting sugary items that make the condition worse. However, the resident loves chocolates and friends and family often send boxes of chocolates to the resident for special events. No amount of positive reinforcement or redirection has worked, and the resident continues to eat the boxes of chocolates. With the resident’s consent, an IBL may involve the facility restricting access to sugary items, such as screening and removing packages that contain chocolates before they reach the resident or from the resident’s room. Similarly, a resident may have a history of substance use disorder but is working hard to refrain from falling back into old habits. The resident has friends from those days and knows it is hard to decline visits from these friends or tell them “no” when they invite the resident out. The facility may work with the resident to implement an IBL that restricts visits by having staff escort these friends to the unit, redirecting attempts to visit at certain hours, or monitoring visits to support the resident and help the resident avoid leaving the facility with them. Alternative, less restrictive means must be attempted first, but there are specific, assessed needs that may be best supported by a well-documented IBL to promote resident preference, choice, and quality care.  Eugenia Liu is the SVP and General Counsel at OHCA.

www.ohca.com SPRING/SUMMER 2024 The Oregon Caregiver 15 PUBLIC POLICY Resident Experience Drives Policy Priorities By Libby Batlan, Oregon Health Care Association Resident care is at the heart of everything we do at OHCA, including how we develop our legislative agendas. On March 7, Oregon concluded its most recent legislative session. Even-numbered years mean the Legislature meets for a shorter period of time—less than 35 days—with a focus on addressing urgent budget and policy needs. OHCA brought forward three bills with the goal of relieving regulatory burdens on providers and improving the resident experience in Oregon’s long term care system. House Bill (HB) 4122 is the next step forward in the years-long process to modernize and strengthen Oregon’s background check system. We heard stories from providers on a weekly basis about challenges with struggling to get background checks returned for individuals applying to be caregivers at their facilities or agencies. It is not uncommon for the State to take 30 to 45 days to process a background check. This inefficiency exacerbates the workforce shortage and has been contributing to the issue we’ve seen with a “staffed-bed” capacity being lower than a facility’s true capacity, due to a lack of qualified staff. What happens when background checks get backlogged is that applicants may abandon careers in long term care for other employment opportunities where a background check is not needed, and, thus, they can start working sooner. HB 4122 will bring Rap Back to Oregon, which, once fully funded and implemented in 2025, is the long-term solution to Oregon’s background check woes. Rap Back stands for “Record of Arrest and Prosecution Back.” It is a fingerprint-based system that allows for the state to connect to the FBI’s background check database; it continuously checks enrolled employees’ records against incoming arrest or conviction information. This eliminates the need for background re-checks over time and enhances consumer safety. Ultimately, making Oregon a “Rap Back” state is the most efficient and thorough way to fix what is broken with our state’s system. However, it will require frontend work from providers and workers to come into compliance with its protocols. Notably, every caregiver subject to background checks by law—both current and prospective—will need to be fingerprinted. OHCA will keep our members updated as Rap Back is implemented. The second staffing-related bill OHCA championed this session is Senate Bill (SB) 1521, which makes critical changes to acuity-based staffing requirements (ABST) for assisted living, residential care, and memory care communities. The recent implementation of acuity- based staffing tool (ABST) mandates in community-based care settings by the Oregon Department of Human Services (ODHS) resulted in many challenges and an inordinate number of conditions being placed on provider’s licenses despite their best efforts to comply. SB 1521 aims to accomplish three key things: • Clarify that ODHS is only required to place a condition on a facility’s license for substantive issues related to a facility’s use of an ABST or for the insufficiency of staffing levels to meet the residents’ scheduled and unscheduled needs, 24/7. This is aimed at reducing the instances of facilities receiving conditions on their licenses for ABST violations if the conditions are related to technical issues with the tool. • Require ODHS to consider the impact and administrative burden on facilities before changing rules around minimum requirements and design of an ABST to help ensure compliance targets do not change on a whim. • Remove the requirement that a facility with an ABST-related condition on its license be continuously monitored for six months and replaces it with a requirement that the continuous monitoring may be lifted once the department removes the condition. Lastly, OHCA was successful in extending the nursing facility provider assessment through HB 4033. Under the bill, the assessment will be extended for six more years to 2032. Since the assessment is a key component of Oregon’s Medicaid rate-setting methodology for nursing facilities, the passage of HB 4033 provides certainty and stability for these facilities and ensures that Oregon’s innovative and success rate-setting process will continue for the near future. All nursing facilities in Oregon except for the two Oregon Veteran’s Homes pay the assessment and most see a net benefit from their investment. Taken together, we believe these bills will improve and support the experiences of residents receiving care in long term care communities across the state. We know that in order for Oregon’s long term care system to thrive we need appropriate regulatory actions and adequate funding, and this will continue to drive our policy efforts in upcoming sessions.  Libby Batlan is the SVP of Government Relations at OHCA.

The Oregon Caregiver SPRING/SUMMER 2024 www.ohca.com 16 SPONSORED CONTENT Senior living resident preferences and profiles are changing. Innovation in the dining room today can help demonstrate to future residents just how committed you are to exceeding their expectations at mealtimes. Not only is the baby boomer generation in the United States more ethnically diverse than those who came previously, they are more well-traveled and spent more of their expendable income on a wider array of restaurants and experiences. They’ve learned about growing methods and have shopped at farmer’s markets. All of this means that their expectations around dining options will create the need to change among senior living dining operations. Here are some factors to consider when updating your menus and programming to meet these changing needs. How It’s Grown Senior living residents have a wealth of knowledge regarding food production methods. Not only are the older generations more likely to have been raised on farm or in a farming community, but they learned more about sustainability and the importance of supporting local agriculture as those ideas grew in popularity over the last 20 years. Local, sustainably grown produce options will be welcome on your menus. Your residents may also enjoy a lecture by a local farmer, a chef demo using locally grown produce, or hosting a farmer’s market at the community. If you are a Sysco customer, you can access a broad array of sustainably produced products —and it doesn’t have to break the bank. Global Flavors New residents are more likely to have traveled more extensively and sampled more diverse cuisines than generations Embracing Diversity in the Dining Room By Jen Bruning, MS, RDN, LDN, Incite Strategic Partners past. Look at what types of cuisine are popular in your local community and consider integrating specials based on what is offered in local restaurants. Use calendar holidays from various cultures and religions like Lunar New Year, Diwali, and Eid to inspire residents to sample new dishes and allow some creativity among your cooks and chefs. Demographics Historically, most residents in senior living have identified as Caucasian/ White. While that majority is still seen today in Oregon, the ethnic, cultural, and religious make-up of older adults is shifting to be more diverse. Consider enhancing your menu with quality speed-scratch or convenience products to help meet the needs of all your resident preferences. Ensure that each resident has the chance to voice their preferences based on their culture and religion, and don’t make assumptions based solely on words on an intake form. Just because someone states they are from a certain ethnic or religious group does not mean that they follow all traditional practices. Specific Dietary Requirements As more residents move into their new homes, you may notice an uptick in the number of individuals following a specific diet pattern. This may be due to a medical need like a diagnosis of celiac disease or could be the result of a preferred eating style for health and longevity. Working with a registered dietitian can help to sort out any confusion over what foods may and may not be included in a resident’s preferred eating style. (If your community does not employ an RDN, see if they’d consider hiring one on contract for a menu review project or consult your food service/ purchasing provider to see if they offer these consultants for free.) Since cooking to order for every resident can be challenging, there’s a good chance that with just a few tweaks, your existing menu can meet the ever-expanding needs of your resident population. If you’re a member of Incite Strategic Partners, reach out to your member success representative to learn more about menu options that fit within your budget! Menu changes to meet residents’ needs and desires may feel daunting. Start with small changes and ask yourself: What do we already do that delights our residents? What can we add to enhance their experience? What is realistic for our team and budget? Who do I know that can provide support and guidance? Involving residents, your team, your leadership, and your support partners like Incite and Sysco in the menu changing process can help you ensure continued success and resident happiness.  Jen Bruning is the director of nutrition and brand innovation with Incite Strategic Partners, OHCA’s purchasing partner and an OHCA business partner. This article has been sponsored and provided by Incite Strategic Partners. Menu changes to meet residents’ needs and desires may feel daunting.

The Oregon Caregiver SPRING/SUMMER 2024 www.ohca.com 18 provide to nurses through my role at NurseLearn” July says. “Because, I wanted to do a good job. I needed to do a good job—for my residents, for my care staff, for my growth as a nurse, for my own self- confidence, and for this very special place in old town Portland that made me feel like I belonged.” “Now, as a mentor, I strive to be a change agent for nurses that find themselves in my similar situation: feeling isolated, craving support, in constant search for resources and answers, and learning solely through trials and tribulations,” she says. “Because through it all, we are committed to the residents and their care, to the team, to the community, and to this special corner of the nursing world where we belong.” For more information on NurseLearn’s free enhanced program for nurses in community-based care, visit https://nurselearn.com/odhs/.  July Lumague-Test is the lead nurse mentor at NurseLearn, an education resource for nurses in community-based care settings. Meet July Lumague-Test, MN, RN, NE-BC, the lead nurse mentor at NurseLearn, a free education and resource hub for nurses in community-based care settings. July’s story starts straight out of nursing school. “My first nursing job in the hospital setting quickly confirmed what I already knew about myself and where I did not have an interest in growing as a nurse. I innately knew that the hospital setting wasn’t the right fit for me.” But, with her formal training and education positioning her for a career in acute care, July found herself asking, “Where do I belong?” “In my search for professional growth, I applied to many different healthcare settings,” she recounts. “And, by pure luck—or some may call it fate—I landed a job as a nurse at an assisted living facility. Not just any assisted living facility, but a facility in Old Town, Portland that serves a population of residents with a history of addiction, incarceration, homelessness, trauma, and complex behavioral and mental health needs.” With her background in special education—where educators are trained to take a “whole-child” approach that considers how learning outcomes depend not only on the quality of education, but also on a number of social and personal factors like safety, physical health, mental health, and access to support systems—community-based care (CBC) nursing came naturally to July. “This approach of looking at the resident as a whole person, whose life experiences and life situations matter just as much as their diagnosis and medical history, was something that I automatically did.” “It was in this specific role, in this exact building, where I found my niche. Really, it’s where I found myself. It’s where I grew as a nurse. It’s where I tried and failed and got up to try over and over again. It’s where I succeeded. It’s where I thrived. It’s where I became a nurse leader,” she remembers. “It’s where I belonged.” July’s path was not without its difficulties, though. “The journey was truly a struggle,” she shares. This role can be isolating. “Being the only nurse in the building, I felt alone, without peers to lean on and separated from the rest of the nursing world. There was so much that I didn’t know, including where to find answers, who to reach out to, or even what questions to ask.” “Words cannot describe what a difference the support, advocacy, and guidance of mentorship would have made for me at the beginning of my CBC journey—the kind of mentorship I am now able to July Lumague-Test instructs nurses as part of NurseLearn’s programming. Journey to Community-Based Care Nursing: Caring for Residents as Whole People Interview with NurseLearn’s Lead Nurse Mentor, July Lumague-Test By Alayna Amrein, Communications Coordinator, NurseLearn SPONSORED CONTENT

www.ohca.com SPRING/SUMMER 2024 The Oregon Caregiver 19 Ronnie Jacko 503-445-2234 [email protected]

The Oregon Caregiver SPRING/SUMMER 2024 www.ohca.com 20 PROFILE Corissa Neufeldt, Safety and Regulatory Deputy Director, Oregon Department of Human Services (ODHS) LEADER Corissa Neufeldt is the safety and regulatory deputy director for the Office of Aging and People with Disabilities within the Oregon Department of Human Services (ODHS). She has been in public service for nearly 30 years, working at the international, state, and county levels. She has spent the majority of her career working with and advocating for individuals with intellectual and developmental disabilities. What part of your job is the most rewarding? What is the most challenging? The most rewarding experience that I have had throughout my career is just knowing that I have helped somebody. There have been stories and instances that stick with me, and I have lost sleep over, but it is so fulfilling having been able to assist individuals through support, intervention, and access to services that resulted in them being healthy and safe. Seeing struggling providers, who are having a difficult time maintaining their facilities, be successful in helping meet the needs of their residents makes the job worthwhile. The biggest challenge is the mass machinery and strains that comes with working at a government agency. You can come up with a brilliant idea, but by the time you get everything in place that you need to bring the idea to fruition, it can be two or three years later, which can be frustrating. What goals does ODHS have for the upcoming year? What challenges are you facing? My position is a new position, and it was brought on because leadership identified that there needed to be someone who could pay closer attention to the licensing and regulatory work and the adult abuse protection work that we have. My goal in the next year is to update our regulatory rules and policies, and really ensure that we have our best practices in place to ensure the health and safety of residents. These policies need to be reflective of our current mission and values, not values from ten years ago. What is a stigma about working at a government agency that you would like to dispel? That we don’t care about the residents. The myth is that we are just government workers earning a paycheck and we don’t really care about the people in the facilities. That is not at all the case. Everybody has a choice of where they work, and my colleagues and I are choosing to work here because we care. I have chosen this line of work because I care about people, particularly vulnerable and marginalized people, and I can say the same for many of the staff. How do you communicate the importance of home and communitybased services (HCBS) to providers? In Oregon, we have the ability to support vulnerable populations in the community or in their homes. The main thing we have tried to communicate to providers and caretakers is the importance of an individual’s right to make choices, regardless of geography: residents’ rights don’t go away just because they are choosing to receive services, either in their homes or in community settings. This is mainly communicated through the administrative rules and training that all administrators and providers must go through to receive their licenses from the state. What do you think is the biggest positive outcome from the implementation of HCBS? The increased understanding and acceptance that just because you are requiring support doesn’t mean that you don’t have rights and that you don’t have the right to make choices. HCBS is the embodiment of supporting residents in their choices versus directing and projecting your opinions about what somebody should do. It is the difference between what is important to the individual versus what is important for the individual. These might conflict at times, and that is where choice comes into play. HCBS is all about how we support person-centered choices versus projecting our own judgments on people. 

www.ohca.com SPRING/SUMMER 2024 The Oregon Caregiver 21 Senator Suzanne Weber, (R-District 16) POLICY MAKER Senator Suzanne Weber currently represents Senate District 16, which encompasses all of Clatsop, Columbia, and Tillamook County. She serves on many committees including Senate Human Services, Senate Education, and the Joint Committee on Education. Senator Weber served on the Tillamook City Council and then as the Mayor of Tillamook, following her 30-year career as an elementary school teacher. Serving on the Senate Human Services Committee, what have you learned about Oregon’s long term care sector that you didn’t know before? I learned just how much human services are in control of and take care of our state, and also how our long term care services for our elderly and our disabled are just one small part of it. I didn’t recognize how our human services agency is so engrained in the care and help of those who need that long term We are all aging, and we need to make sure that we have the people within the legislature who can sustain us and take folks forward. We need to be aware of things that can help people legislatively. It might just be small tweaks here and there that could make someone’s life better, not only on an individual basis, and also improve the health of the whole state. care. Also, I didn’t realize how many issues can come up that can impact the services that people get, including the lack of facilities and places for people to go when they need that long term care. There are so many things that impact the services that we need, especially long term care. What policies and issues are you most passionate about? I’m really interested in what we can do to make sure that long term care is secure, but then there are other issues that I am also really concerned about. I am concerned with in-home care, as well as disability services, because Oregon has a sizeable population of people who need help within their homes and are disabled. I also care a lot about preventing child abuse and neglect. If we are not taking care of our children, we are failing as a society. They are our future. Oregon also has a high rate of youth suicide, so I am passionate about continuously working on those crisis lines and making sure that we are helping all people, young and old, through difficult times. Do you feel like your passion for education and children intersects with the senior population? If yes, how so? I feel there is a direct correlation between the needs of children and of the aging population. I think that they intersect, and they have some of the exact same needs. Shelter, food, security, and confidence. All of those needs are the same. If you are advocating for children, you must also be advocating for the elderly and folks that need special care and support. What is your favorite thing about Oregon? My favorite thing about Oregon is a 70-degree day on the coast, sun shining bright, a slight breeze, and clear beach CONTINUES » PROFILE