OHCA The Oregon Caregiver Spring Summer 2023

A Publication of the Spring/Summer 2023 Oregon Health Care Association Tips for Survey Day | Q&A with Rep. Valderrama | Spring Expo Highlights A Day in the Life of Essential Long Term Care Workers

SPRING/SUMMER 2023 © 2023. 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 17 20 27 pg6 A Day in the Life of Essential Long Term Care Workers In this article, step into the shoes of various long term care workers, including a caregiver, a cook, and a social services director in different settings, to get a taste of their daily routines and see the impact they make on the residents in their care. 04 LETTER FROM THE CEO 06 LONG TERM CARE PROFESSIONALS’ DAILY EFFORTS TO PROVIDE QUALITY CARE 10 QUALITY Best Tips to Prepare for a Survey Day 12 LEGAL & REGULATORY A Quick Overview of the Regulations, Laws, and Rules Facilities Must Follow and Balance Every Day 14 PUBLIC POLICY What a New Legislature Means for Long Term Care 16 DATA & RESEARCH Various Effects of Inflation on Oregon’s Direct Care Workforce 17 SPONSORED CONTENT A Day in the Life of Your Produce A Day in the Life of a Restoration Process in Long Term Care 20 PROFILES Afra Mayfield (Regional Director of Operations, One Life Senior Living) Sandy Allision (Rose Linn Care Center) Representive Andrea Valderrama (D-District 47) 27 2023 SPRING EXPO 28 UPCOMING EVENTS

The Oregon Caregiver SPRING/SUMMER 2023 www.ohca.com 4 Every individual working in a long term care community plays a crucial role in ensuring that Oregon’s seniors receive the care they need. From nurses and caregivers to housekeepers and cooks, each role is an integral part of the puzzle that makes up long term care services and supports. The staff work tirelessly to provide compassionate care, support, and assistance to their residents. In this issue of Oregon Caregiver, we take a look into the daily routines of professionals, and a resident, involved in long term care to provide a better understanding of what they do day in and day out. In our feature article, we profile various long term care workers, including a caregiver, a cook, and a social services director in different settings, to give a taste of their daily routines and how their work is vital to the health and wellbeing of the residents in their care. In our quality article, Nicolette Reilly details what it looks like during a survey day in a long term care community and offers tips to help providers navigate through and prepare for a survey. OHCA general counsel Eugenia Liu explores the extensive rules and laws that skilled nursing, assisted living, and residential care communities must navigate and balance each day to provide quality care to their residents. Libby Batlan, OHCA’s SVP of government relations, highlights the 2023 Oregon Legislative session and highlights key bills that will impact our sector. Inflation directly impacts the workforce, not only in wages, but also the day-to-day lives and experiences of direct care staff. Walt Dawson, OHCA’s research consultant, dives into the data. Two OHCA business partners share their roles in providing quality services to long term care providers. Incite Strategic Partners, OHCA’s member purchasing partner, details the day in the life of your daily produce, while Summit Cleaning and Restoration illustrates what to expect during restoration efforts. In our policymaker profile, Representative Andrea Valderrama shares how her lived experiences and commitment to racial, economic, disability, gender, and climate justice drive her budget and policy decisions for Oregon. Hear from Sandy Allison, a resident from Rose Linn Care Center, who shares what her typical day looks like living in a skilled nursing facility. Review highlights from the 2023 Spring Expo in Salem and save the dates of important in-person and online events and trainings, including the 2023 Annual Convention in Portland coming up later this year. You can read this magazine and all past editions of the Oregon Caregiver on our website, www.ohca.com.  A Day in the Life of Essential Long Term Care Workers 11740 SW 68th Pkwy, Ste 250, Portland, OR 97223 Phone: (503) 726-5260 www.ohca.com OHCA STAFF Conner Allen • Member & Administrative Services Coordinator Libby Batlan • Senior VP of Government Relations Philip Bentley, JD • President & CEO James A. Carlson • Advisor 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, LNHA • Senior VP Quality Services Catherine Van • Communications Specialist Rosie Ward • Senior VP of Strategy BOARD OF DIRECTORS CHAIR Kathy LeVee, Generations, LLC IMMEDIATE PAST CHAIR Steve Fogg, Marquis Companies, Inc. VICE CHAIR Rick Miller, Avamere Health Services TREASURER Mark Remley, Gateway/McKenzie Living NON-PROPRIETARY REPRESENTATIVE JoAnn Vance, Providence Child Center MULTI-FACILITY REPRESENTATIVE Ryan Delamarter, Prestige Care, Inc. MULTI-FACILITY REPRESENTATIVE Jonathan Allred, EmpRes Healthcare Management, LLC 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 Andy Becker, Sapphire Health Services 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 Charles Bloom, Latitude Healthcare Properties OC EDITORS Catherine Van • cvan@ohca.com Rosie Ward • rward@ohca.com OC PUBLISHER LLM Publications • www.llmpubs.com Advertising Sales • Ronnie Jacko (503) 445-2234 • ronnie@llmpubs.com Design & Layout • Shelby Bigelow Phil Bentley President and CEO Oregon Health Care Association LETTER FROM THE CEO Stay connected with OHCA! Contact Catherine Van, cvan@ohca.com, to be added to our email lists.  Improving lives by advancing quality care in Oregon since 1950

The Oregon Caregiver SPRING/SUMMER 2023 www.ohca.com 6 FEATURE LONG TERM CARE PROFESSIONALS’ DAILY EFFORTS TO PROVIDE QUALITY CARE By Catherine Van, Oregon Health Care Association Every day, thousands of Oregonians care for and impact the lives of older Oregonians receiving care in long term care communities and in their homes. Nohemi Flores Sanchez, caregiver at Home Instead Erin Hoscheid, social services director at Rose Linn Care Center Austin Comer, cook at The Springs at Mill Creek Caregivers and staff provide direct essential support to individuals who require assistance with daily tasks like showering and recreational activities, healthy food preparation, medical care, and emotional support. Staff and other individuals also provide an immense amount of indirect support like providing social services work, purchasing and disseminating all kinds of medical supplies and food items, keeping buildings in working order, greeting visitors, and so much more. The roles within long term care settings can vary depending on the type of community, resident acuity, capacity, and other factors, encompassing a wide range of professionals such as administrators, caregivers, kitchen staff, activities professionals, nurses, and social services professionals. While their daily routines may differ, one common thread is the unwavering display of kindness, compassion, and selflessness as they dedicate themselves to caring for others. A career in long

www.ohca.com SPRING/SUMMER 2023 The Oregon Caregiver 7 FEATURE CONTINUES » term care can be both challenging and rewarding for these workers, as they navigate the complexities of caring for individuals with various physical and mental health conditions as well as the ever-changing regulation landscape. Despite the many challenges they may face, they often find fulfillment in their work, knowing that they are making a positive impact on the lives of those in their care. To understand just a sliver of what some long term care professionals experience on a daily basis, we’ve collected some “day in the life” stories from individuals in Oregon’s long term care communities. A Day in the Life of a Caregiver For Nohemi Flores Sanchez, caregiving is a calling. After spending 17 years working in the technology space, she left her job at Intel to embark on a career that would make a bigger impact on peoples’ lives. Having grown up in a multi-generational home, Sanchez says caregiving is a cultural value that Latine families like hers hold dear. She knew becoming a caregiver would give her the purpose she had been seeking in her professional life. She earned her CNA certificate and spent the next eight years as a caregiver, working one-on-one with clients in their homes as well as in different long term care communities. She currently works as a rapid response care practitioner for Home Instead, serving in Columbia, Yamhill, and Washington counties. “I love what I do. You get to know people on a really personal level,” she said. Morning On a typical day, Sanchez provides care for on average of three people and she starts her workday at 8 a.m. Prior to arriving to her client’s home, Sanchez reads their individual care plan thoroughly and examines what tasks to perform. Once she arrives at a client’s home, if they are mobile and audible, she discusses what they would like to do for the day. They then prepare breakfast together and follow their routine. If a client is bed-bound, she will take care of certain tasks like emptying their catheter bag. Afternoon Once the afternoon rolls around, it’s time for lunch. Some clients may get Meals on Wheels deliveries while others prefer homecooked meals. Sanchez helps get her clients in the seat where they like to eat, cuts their food into smaller pieces, and helps feed them if needed. Sanchez says she goes into the lunch period with patience and takes things slowly. After lunch, some of her clients take naps or go on a walk outside. If there aren’t any errands or appointments, she tries to keep them active and engaged in activities, including playing games, watching television, or reading books. Evening Sanchez usually wraps up her day around 5 p.m., and on the rare occasions that she has to work late, she makes sure her clients have their medication and dinner ready. She also draws them baths and gets them ready for bed, making sure they feel safe when they fall asleep. She loves her job so much that sometimes on her days off, she goes in to socialize with her favorite clients who she has fondly coined her “grandmas” and “grandpas.” At the end of the day, Sanchez knows helping with small tasks means a great deal to her clients. She knows her clients need encouragement and companionship, something the COVID-19 pandemic robbed them of for years. She knows her clients need a reason to keep going and she wants to be the one cheering them on every day. “I can sleep better at night knowing I made a difference—no matter how insignificant it may seem—in someone’s day,” said Sanchez. Each day has its own challenges. Clients may feel uneasy having a stranger come into their homes, but once they get to know the caregiver, Sanchez says the best part is hearing their stories and getting a glimpse of their younger lives. “I like talking to my clients, if they can speak, to hear their life stories. They tell me stories of who they married, how they met, what they did growing up, and what their childhood was like,” she said. “I love hearing stories and looking at photo albums and their art. It’s amazing what you learn.” A Day in the Life of a Cook Dining plays a crucial role in forging bonds and creating special memories. For many long term care residents, mealtimes are the best part of their day. Community cooks like Austin Comer understand the important role they play in the residents’ lives. Comer grew up cooking with his grandfather, experimenting with recipes, and preparing meals for his grandmother. His curiosity in the kitchen carried into his adulthood as he started working at Taco Bell, quickly becoming the assistant manager. His need to get back in the kitchen and make a bigger impact on someone’s day, other than training employees and creating schedules, landed him a job as a cook at The Springs at Mill Creek in The Dalles. Comer shares his daily routine as a cook in long term care. Morning Comer starts his days as early as 6:30 a.m., prepping entrée specials and other meals for the day. Once he and his fellow cooks get through the morning rush, they prep for the busiest time of the day: lunch. “I can sleep better at night knowing I made a difference—no matter how insignificant it may seem—in someone’s day.” – Nohemi Flores Sanchez, caregiver, Home Instead

The Oregon Caregiver SPRING/SUMMER 2023 www.ohca.com 8 FEATURE » FEATURE, CONT. “My favorite part of the day is usually lunchtime when I get to see the team’s hard work pay off with happy and well-fed residents,” said Comer. “I really enjoy knowing I play a role in the residents’ day; it’s a feeling of pride that I’ve never felt before.” A favorite dish of residents at The Springs at Mill Creek is the meatloaf and its special sauces. Comer loves to prepare hearty meats like steak and chicken and will leap at every opportunity to crack open the grill. This community prides itself on having fresh food cooked every day, with cuisines from around the world. As the cook of the day, Comer often runs the soups and desserts, but the main dishes give him the freedom to experiment with ingredients. His favorite original creation is turning a creamy mushroom chicken dish into Pollo a La Crema, which contains chicken, cream cheese, sour cream, tortilla, beans, and rice. Comer hopes it will be added to the regular rotation. Afternoon Once the lunch rush ends at around 2:30 p.m., Comer prepares the meals and desserts for the next day’s menu. The cookies, which are made from scratch, are the residents’ favorite dessert. Comer says one of the perks to being a cook is working in a location that smells good all the time. Evening At the end of his shift, Comer cleans and sanitizes his cooking stations and lends a hand to any colleagues who need additional support. Comer goes home knowing he made a difference in the lives of residents. “Food can make a bigger difference than filling a belly,” said Comer. “I love my job because I get to be a part of the residents’ favorite part of the day. It makes me feel accomplished every day knowing the residents are fed and content with their food!” Working in the long term care sector has taught him to be patient and receptive to feedback. With a few more years of experience in the kitchen under his belt, he hopes to be an executive chef and aspires to one day own his own restaurant. A Day in the Life of a Social Services Director In long term care, the role of social services staff and social workers is complex and multi-faceted. Erin Hoscheid, the social services director at Rose Linn Care Center in West Linn, describes her role as a “catch all” for anything that falls in between nursing, activities, dietary, and business operations. She has been in her role since the thick of the COVID-19 pandemic in May 2020 after working as a CNA and med tech for several years. “I found working as a CNA and a med tech at nursing facilities so incredibly rewarding,” said Hoscheid. “Through my few years of nursing school and my time working at a short-term skilled nursing facility, I’ve come to realize that I prefer working with long term residents who I can get to know well over time. They become like family, and I enjoy being able to make a difference over a longer period in their lives.” As a social services director, Hoscheid completes care plan reviews and data assessments on a quarterly basis. During these reviews, she evaluates hearing, vision, dental, cognition, communication, behaviors, mood, and discharging plans. All this information is recorded in the resident care plans where staff interventions and goals for each issue are written. She also manages ancillary services for residents, including hearing, vision, podiatry, and dental. When there are concerns or complaints, she is responsible for resolving them by looping in the appropriate people and resources. From keeping inventory of resident belongings to coordinating transportation, to coordinating a smooth discharge plan, Hoscheid covers a wide range of responsibilities daily to enable each resident to function at their highest possible level of social and emotional wellness as they transition into or out of the care environment. Stir fry and an eggroll is a one of many dinners prepared by Comer. “I like to take time to talk with multiple staff members about residents to get a fuller picture of how they are doing and what issues they may be having. Progress notes don’t really paint a full picture of what is going on with a resident.” – Erin Hoscheid, social services director, Rose Linn Care Center

www.ohca.com SPRING/SUMMER 2023 The Oregon Caregiver 9 FEATURE Morning Hoscheid starts her day at 9 a.m., greeting residents as she makes her way to her office to answer pressing emails and prep for the morning meeting. At this meeting, she and her staff discuss daily events; duties for housekeeping, maintenance, and dietary staff; the health status of the residents; any behavioral issues from the previous day; and compliments and complaints her building has received. Afternoon Throughout the day, Hoscheid works on projects and attends meetings, making sure she meets deadlines and addresses any concerns from residents and families in a timely manner. During the afternoon, she conducts resident and staff interviews. As part of the assessment requirements, she interviews each resident on a quarterly basis to complete their care plan reviews. “I like to take time to talk with multiple staff members about residents to get a fuller picture of how they are doing and what issues they may be having. Progress notes don’t really paint a full picture of what is going on with a resident,” said Hoscheid. “CNAs and charge nurses know the residents better than anyone else in the building because they work with them the most. Their input is truly invaluable. All this information helps me make more complete care plans and find specific interventions that work for a resident.” Evening Before Hoscheid finishes her day, she works through grievances and misunderstandings with residents and their families, which can often be caused by language barriers, cultural differences, or clashing personalities. At the end of the day, she says her staff care deeply for the residents and are all doing the best they can for them. “My favorite part of my day is seeing the positive impact our team makes on our residents. Seeing them smiling and laughing, feeling more comfortable, and enjoying life is incredible” she said. It’s particularly important for Hoscheid to be able to work in an environment that makes a real difference in people’s lives. She’s an advocate for those who may feel undervalued or who no longer have a voice of their own. “I love being able to be there for them even if family and friends are not. I love becoming a part of their family in this way,” she added. While sometimes demanding and challenging, each role within the long term care sector is also incredibly rewarding. These dedicated individuals work tirelessly to ensure that elderly and vulnerable Oregonians receive the care and support they need to lead happy and fulfilling lives. From the cooks and caregivers to social workers and administrators, each role is vital to the overall success of the long term care sector. Their hard work and dedication don’t go unnoticed and must be continuously supported. 

The Oregon Caregiver SPRING/SUMMER 2023 www.ohca.com 10 Best Tips to Prepare for a Survey Day By Nicolette Reilly, Oregon Health Care Association As a long term care provider, many circumstances may cause stress or anxiety in the workplace. However, few situations cause more stress than when surveyors from the state walk into a building to conduct an inspection survey. On the first survey day, an unannounced group of state surveyors enters a long term care community to review operations and compliance with federal and state rules and regulations. Not only does this create a stressful environment, but it also typically upends the day-today operations as the team works together to try to ensure strong communication with the survey team and clear representation of the wonderful work being done in the communities. While participating in an inspection may be overwhelming, there are appropriate ways to get a community ready for one without adding another layer of stress and frustration. Survey Process The survey process should be collaborative with a genuine focus on the residents and on ensuring quality services are being delivered based on individual person-centered care plans. The survey process seeks to ensure a safe and secure environment to enhance residents’ dignity, independence, individuality, and decision-making ability. The focus is to keep the residents at the center to ensure they are functioning at their highest level possible. Surveyors will determine this based on record review, observations, and interviews. Record review is initially performed to provide the surveyor with information on issues a resident may experience to help guide observations and interviews. An in-depth record review is conducted to follow-up on concerns and to complete certain survey requirements. Observations will include the provision of care and services as well as interactions between residents, staff, family members, and outside partners. Observations will also focus on cleanliness, safety, and adherence to the Oregon Administrative Rules (OARs). One-on-one interviews will be conducted with residents, families, and staff to provide information about the care delivered at the facility. The best way to prepare for a survey is to never stop preparing for a survey. The survey process should not be a fire drill but rather a carefully planned and executed process based on preparation and implementation of strong quality improvement auditing. Preparing a team for a survey and equipping them with the appropriate tools to successfully navigate through a survey will ensure a calm, stress-free experience. Pre-Survey Checklist Focusing on some key processes will help during the survey process. • First and foremost, ensure all leaders know the regulations. Department managers should firmly understand and be well trained in OARS and organization policies and procedures. • Ensure organization policy and procedures are up-to-date and are reflective of the most current regulatory rules. • Department managers should be able to explain these policies and procedures and show clear documentation of compliance to them, including sharing how they are aligned with regulatory requirements. It is also important to do a full review and walk through of the community on a regular basis. • Look at aspects that are seldomly inspected. • Open doors that are rarely opened. • Focus on both front and back of the facility as well as the exterior grounds. • Look for safety issues and environmental issues that may lead to a potential citation. Communication It is also important to create a culture of open communication with your residents, families, and team members. Talk with those individuals to uncover any issues and implement plans of correction. A strong grievance process with timely follow-up as well as regular satisfaction surveys or listening sessions will allow issues to be handled in advance. Quality Improvement A strong quality improvement process that encompasses key work processes will allow the facility to be proactive in resolving issues. To achieve this, providers should implement strong action plans to improve and continue to offer quality services to our residents. Auditing multiple systems that are reviewed during a survey process as part of the ongoing quality improvement process will ensure that documentation is complete, systems are operating correctly, and issues are resolved. Onsite Survey Checklist and Best Practices • Think carefully before answering any questions from surveyors and take time to consider what a surveyor is looking for. Ask the surveyor to repeat or restate the question if the question is unclear. • Only answer the question that is asked and only give documentation for what the surveyor has specifically requested. • Be honest. If providers don’t have the answers, DON’T GUESS! Tell the surveyor you will find the answer they are asking for as quickly as possible. QUALITY

www.ohca.com SPRING/SUMMER 2023 The Oregon Caregiver 11 • Watch your use of words such as “usually,” “supposed to,” and “sometimes” which may lead the surveyors to question why someone is not consistently following set procedures. • Present material succinctly and clearly. Have confidence in the work you are presenting and be able to clearly articulate your processes. • Know where and how to quickly find documentation to support your answers. • Don’t make excuses or be defensive. • Ask questions. Don’t hesitate to ask questions if something is unclear, especially during the exit conference when potential tags are being reviewed. The survey process should be collaborative as well as educational and is a great opportunity to ensure the provider’s understanding of the rules is aligned with the surveyor’s interpretation of the rules. As a leader in a facility, a survey may create a stressful environment for everyone involved. Fortunately, there are several actions provider leaders can take to help de-stress themselves and their staff, despite the situation. Knowing how to stay calm when managing a team can help providers create a supportive environment and create a sense of confidence throughout the team. • Remain focused on the tasks presented. • Stay calm and positive. Teams will look to leadership on how they drive the culture during a survey. • Be confident in the work that has been done and trust the systems. Trust the strong quality improvement process and policy and procedure adherence. • Rely on the organization’s team. This is a great opportunity to teach others and allow team members to shine. Remember to breathe. If the day gets more overwhelming, take deep breaths to reset. Something Else to Consider— Using Mock Surveys Survey is not something to cram for. Careful planning and auditing will lay a foundation for a successful survey. Conducting a mock survey as a group activity with a team or hiring a consultant to conduct a mock survey will better prepare providers for the actual process. Proper planning is the key to success; it’s simply impossible to know it all. Regulators are people too; they understand that even the most tenured and seasoned leaders lean on others for expertise and experience. The Oregon Health Care Association is available to assist every step along the way.  Nicolette Reilly is the SVP of Quality at OHCA. Sources: • 17 ways to stay calm at work, Indeed Career Development, February 2023 • Tips on how to have a successful CMS survey, By Nicole Sowers, March 27, 2018 QUALITY

The Oregon Caregiver SPRING/SUMMER 2023 www.ohca.com 12 LEGAL & REGULATORY A Quick Overview of the Regulations, Laws, and Rules Facilities Must Follow and Balance Every Day By Eugenia Liu, J.D., Oregon Health Care Association Nursing facilities and communitybased care communities, such as assisted living and residential care facilities, operate under an extremely complex regulatory framework, which is sometimes even at odds with itself. Regulations govern every aspect of operations, from resident care to employee relations, to workplace safety. Facilities must comply with these various regulations every day and, more importantly, all at once. Below, we take a glance into the extensive rules, laws, and regulations that a facility must carefully balance every single day to provide quality care to residents and to support workers. Resident-Focused Regulations The resident is at the heart of everything that a facility does every day, so it makes sense that the majority of the regulations focus on resident care and services. The rules come into play even before a potential resident steps into a facility. There are extensive requirements governing who can be admitted and the processes for doing so. For example, nursing facilities cannot admit individuals with a mental disorder or intellectual disability absent of state approval. Furthermore, both nursing facilities and community-based care communities must complete pre-admission assessments and accept only residents whose care needs they can meet. To promote transparency, the rules require certain pre-admission disclosures. Depending on the type of setting, the required disclosures are outlined in the residency agreement and/or Consumer Statements and Consumer Disclosures, and include details of services offered as well as service limits of the facility, the costs associated with basic services and charges for additional items or services, and the resident’s rights and responsibilities. Once a resident is admitted, detailed rules dictate the comprehensive assessment that must be completed to create a person-centered service plan and the frequency of re-assessments. Under the rules, facilities carefully consider— among other things—the resident’s medical conditions and history, functional status and activities of daily living, cognition, physical impairments, nutritional requirements, preferences, and care goals. Residents also enjoy a broad range of rights and protections so long as the exercise of these rights does not infringe upon the rights or safety or others. These rights include, being treated with dignity and respect, being free from abuse or neglect, participating in the development of their service plans and being able to choose or refuse services, associating and communicating in private with persons of their choice, and being assured privacy during care or having records kept confidential. Facilities also must comply with rules that govern how services are delivered. For nursing facilities, the rules outline requirements for nursing services, physician services, dental services, rehabilitative services, activity services, social services, dietary services, and pharmaceutical services. For community- based care facilities, which is a non- medical social model, the rules focus on the minimum scope of services that a facility must provide, such as assistance with activities of daily living, transportation for medical and social purposes, and medication administration. There are even rules that govern the end of a resident’s stay with a facility. In both settings, residents can only be transferred or discharged for nonpayment and selected medical, welfare, or safety reasons. Then, there are the rules that regulate the building and physical environment. Aside from compliance with general building codes, facilities must meet specific requirements for almost every space in the facility, from resident units to medication to common areas. Additionally, heating systems must be able to maintain certain temperatures and lighting must have certain intensities— measured in minimum footcandles— based on certain areas such as resident The resident is at the heart of everything that a facility does every day, so it makes sense that the majority of the regulations focus on resident care and services.

www.ohca.com SPRING/SUMMER 2023 The Oregon Caregiver 13 LEGAL & REGULATORY rooms, bathing rooms, and corridors/ hallways. Facilities must also comply with life and safety codes, which set forth the requirements for fire and life safety topics. Even though the facility and resident rules and requirements are extensive, there’s more. Employee-Focused Requirements While facilities serve as a resident’s home, facilities are also a workplace for the many dedicated staff who serve residents each day. As such, facilities must address employment rules and regulations in their daily operations. Under the applicable rules, staff must meet certain qualifications, such as background screens, before serving residents. In addition, staff must complete an orientation as well as pre-service and annual training on specified topics, including but not limited to dementia, identifying, preventing and reporting abuse/neglect, resident rights, and cultural competency. Layered on top of the specific rules governing nursing and community- based care communities, there are also general employment laws, such as minimum wage and compensation, payroll, paid leave, and pay equity laws. Facilities also must promote safe and healthy working conditions by complying with workplace safety laws as outlined by Oregon Occupational Safety and Health Administration (Oregon OSHA). Nondiscrimination and Equity On both the resident and employee side of operations, state and federal law provide strong protections against discrimination and harassment. Aside from the resident rights outlined in nursing and community-based care setting rules, broader rules, such as Oregon’s public accommodation law, the Americans with Disabilities Act, and the Fair Housing Act, prohibit discrimination and ensure equal access to care, services, and housing opportunities. Staff enjoy similar protections, and Oregon and federal laws protect staff from discrimination, harassment, and sexual assault at work. Facilities often find themselves in the difficult situation of delicately balancing the rights of residents with the rights of its employees, such as handling residents or family members who engage in abusive, harassing, or discriminatory conduct towards others. But Wait, There’s More Compliance does not end with facility setting specific rules, general employment laws, and non-discrimination laws. Facilities must follow state and federal privacy laws, such as the Health Insurance Portability and Accountability Act (HIPAA), when it comes to protecting and securing personal health information of residents and staff. Facilities receiving Medicare and/or Medicaid funds are also required to detect, report, and prevent fraud, waste, and abuse while participating in the fight against health care fraud as outlined in, among other laws, the False Claims Act and the Anti-Kickback Statute. On any given day, a facility could also be the subject of an unannounced survey or complaint investigation by the state agencies tasked with monitoring compliance of this complicated web of regulations or investigations by the Long Term Care Ombudsman or Adult Protective Services. This plot twist requires facilities to pivot, provide access to facility records as appropriate, and allow staff to participate in interviews if needed, while simultaneously completing the tasks that they need to do every day to meet residents’ needs. Read about best tips to survive a survey day in the previous article. With the plethora of diverse rules and regulations spanning every corner of operations, it is no wonder that nursing facilities and community-based care facilities seem to function in a multi-verse.  Eugenia Liu is the SVP and General Counsel at OHCA.

The Oregon Caregiver SPRING/SUMMER 2023 www.ohca.com 14 PUBLIC POLICY What a New Legislature Means for Long Term Care By Libby Batlan, Oregon Health Care Association Oregon’s legislative session has been underway since January and must adjourn by the end of June. Since the Legislature will still be in session at the time this article is published, the final outcomes are not yet known. However, this article offers a look at what the OHCA government relations team has been focused on this session and what likely outcomes may be. Every Oregon Legislative session is unique. The 2023 session so far brought another “walkout” from Senate Republicans starting in mid-May, which has intensified the unpredictability and cadence of session. It has also brought new legislators to the process. Many legislators are serving in their first term, with even more serving in their first in-person session since the beginning of the pandemic in 2020. During the 2022 election cycle, many longstanding policymakers retired or moved on to different opportunities. This was particularly true for individuals who served in leadership roles, many of whom were in those roles for a significant period. For example, Peter Courtney, the longest-ever serving president of the Senate, retired and Tina Kotek, the former Speaker of the House, is Oregon’s new Governor. The wave of change impacted rank-andfile members in addition to those in leadership positions. Nearly one-third of the seats in the Oregon House of Representatives turned over, giving way to a new generation of legislators chairing key policy committees and budget subcommittees that impact long term care. Higher than normal turnover in the Legislature is a double-edged sword. It provides the opportunity to cultivate new champions for long term care and secure support for the sector. It also means there is significantly more work to do to fill in the deficit of knowledge to Oregon’s long term care system and the needs of OHCA members to be able to serve seniors, grow the workforce, and thrive. Medicaid Rates With a possible recession looming and a nearly $4 billion kicker tax credit to pay next year, lawmakers are operating in a more conservative budget environment and are faced with difficult choices this session. Last biennium, lawmakers had unprecedented amounts of federal funding—nearly $1 billion—to appropriate to programs and services. With that one-time money, the Legislature started new programs, including some for long term care, that now must end or take funding from other sources to stay operational. Over the last three years, OHCA was successful in securing multiple temporary Medicaid rate increases to ensure providers had the necessary resources to respond to COVID-19 and the worsening workforce shortage. Notably, those increases included a 5 percent COVID-19 Add-On for all providers and an Enhanced Wage Add-On (10 percent for community-based care facilities and in-home care agencies and 4 percent for nursing facilities). Both add-ons are scheduled to sunset on June 30, 2023. OHCA is advocating for the add-ons to be made permanent since the cost of care has been fundamentally reset at higher levels. Incorporating both add-ons into the base rate for home and community- based care providers, effective July 1, 2023, will provide true rate stability in the first year of the biennium. We are also asking for a 5 percent cost-of-living- adjustment (COLA) in the second year of the biennium, which would become effective July 1, 2024. For nursing facilities, OHCA is asking the Legislature to fully re-base rates at the 62nd percentile in accordance with the Oregon law. Support for long term care services is not a partisan issue. The sector has strong advocates amongst legislators and budget writers on both sides of the aisle. The challenge for legislators is primarily on funding and sustainability. Medicaid rate decisions will be finalized likely in late June when the Department of Human Services budget bill is adopted. Until then, OHCA will continue to advocate effectively on behalf of providers. Temporary Staffing Agency Costs and Quality Oregon continues to lead the way in reforming the temporary staffing agency industry. Long term care providers have experienced poor business practices and skyrocketing rates from some staffing agencies, which have negative outcomes for providers, workers, and consumers. House Bill 2665A is a central component of OHCA’s legislative agenda this session. The bill establishes annual maximum rates that temporary staffing agencies may charge providers as well as ensure staffing agencies are held accountable for deploying high quality, appropriately trained staff to long term care facilities and hospitals. Capping business-to-business contact rates through government action is a challenging proposition and tends to divide along party lines. Ultimately, OHCA’s advocacy for this bill is based on containing the cost of care for providers, ensuring care staff are treated equitably,

www.ohca.com SPRING/SUMMER 2023 The Oregon Caregiver 15 PUBLIC POLICY and ensuring residents and vulnerable seniors receive the best possible care. Earlier in session, HB 2665A was approved by the House Behavioral Health and Health Care Committee to Joint Committee on Ways and Means. Lawmakers are still considering this bill. It has not yet passed or failed. Outside of Medicaid rates and reigning in some temporary staffing agencies, OHCA has been engaged in a range of policy issues that may impact long term care this session. From healthcare workforce pipeline expansion, to LGBTQIA2S+ resident rights, to improving the Oregon State Board of Nursing expertise in long term care, there are hundreds of bills OHCA has passed, amended, or stopped all together on behalf of its members as we continue our mission of advancing quality care for Oregonians in long term care settings. Please reach out to OHCA’s government relations team if you have questions about legislative efforts.  Libby Batlan is the SVP of Government Relations at OHCA.

The Oregon Caregiver SPRING/SUMMER 2023 www.ohca.com 16 DATA & RESEARCH Inflation has reached levels unseen in more than 40 years. Meanwhile, it has been more than one year since the Federal Reserve began cutting interest rates in an attempt to drive down inflation. While some inflation is assumed to be a sign of a healthy economy—usually around 2 percent annually—inflation reached a high of 8.2 percent in October 2022, which is far above a healthy annual threshold. Despite the Federal Reserve’s efforts to curb inflation, it remains stubbornly high. Much has been written about the impacts of inflation on wages and other business- related costs across the U.S. economy including the longterm care sector. Given the immense impact of inflation, along with other historic workforce challenges, it is impossible to ignore this important topic. What effect is inflation having on staff working in long term care communities, and how might the day-to-day impacts of inflation be contributing to the wider workforce issues that are taking place across Oregon? Since the COVID-19 pandemic, wage growth has been significant in many parts of Oregon’s economy, including the long term care sector. A recent report from Portland State University’s Institute on Aging showed that the average wage for direct care staff in Oregon’s community-based care settings is $17.40. This is a significant growth since 2020 when the average hourly wage was just above $15.00. Yet, there is little doubt that rising inflation affects an individual’s purchasing power very simply by decreasing the number of goods or services they can purchase. In February of 2023, one would need an additional 16 cents for every dollar earned to have the same purchasing power as in February 2020 according to the U.S. Bureau of Labor Statistics. The way this additional 16 cents per dollar is distributed across the economy is uneven with some areas impacted much more than others. Nevertheless, this makes the goods and services that direct care staff need to live and thrive increasingly more expensive. Perhaps most troubling are food costs, which remain particularly high, increasing by 11.4 percent last year alone, according to the U.S. Department of Agriculture. Rising housing costs are another major concern for many Oregonians. In April of 2023, the median monthly rent for a two-bedroom apartment in Portland was $1,950. In Coos Bay, the cost was $1,600, while in Hermiston it was $1,295. According to the Zillow Home Values Index, the average cost of purchasing a home in Oregon is $474,360. Various Effects of Inflation on Oregon’s Direct Care Workforce By Walt Dawson, D.Phil This number is only an average and the purchase price varies greatly by geographic area. According to Redfin, the median house price in Multnomah County was $499,000, while in Union County it was $222,000. At the same time, Hood River County had a nearly $800,000 average sale price per home. To be fair, these prices all reflect a slight decline from their peak in 2022. However, what remains clear is that housing costs are unaffordable for far too many Oregonians, in particular those working in long term care settings. With inflation cutting into the value of wages, it is increasingly difficult for many Oregonians to thrive. These challenges are real and palpable for direct care staff in the long term care sector. The instability this creates leads to multiple downstream impacts which directly affect the ability to provide quality care to older adults in need of care and support. Policymakers, along with leaders in the long term care service sector, must remain focused on finding ways to shore up the direct care workforce. The need for care and support will only increase in the years ahead. Some interventions will likely take time for their impacts to be fully realized. Understanding inflation’s day-to-day impact on the long term care workforce is essential for determining how best to respond.  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.

www.ohca.com SPRING/SUMMER 2023 The Oregon Caregiver 17 Senior living operations move at a fast pace. In dining and nutrition departments, that means getting the food order placed in an accurate and timely manner. What happens from there? What is the journey of the food order before it is prepared by chefs and turned into the residents’ favorite meals? A lot of logistics and human energy need to come together to make it possible for kitchens to receive a food order and get it prepared. Here’s a look at the life of a food delivery, from the perspective of a fresh-from-the-field product, like lettuce. From the Field Lettuce is a popular fresh veggie yearround and a must-have for senior living operations. As a food that is almost always eaten fresh, and with a short shelf life, lettuce is harvested and packed right in the field. Working with many small and medium-sized farms, food distributors must have dozens of partners to meet the demands of customers. Held in cold storage, lettuce is trucked to its destination. Food distribution companies, like Sysco, ensure that products requiring temperature control are held in the appropriate temperature range from the moment the cases of product are loaded for transport. Sysco is a major food distributor in Oregon, supplying most of OHCA’s member communities with weekly deliveries and partnering with Incite Strategic Partners to keep pricing affordable. Keeping the food supply safe and wholesome is the top priority in food distribution. Warehouse Huge warehouses with various levels of temperature control store fresh, frozen, and shelf-stable foods. A common misconception is that foods sit for weeks or months in distribution warehouses, waiting to be ordered by customers. However, in most cases, fresh products, like the head of lettuce, sit for only 2–3 days maximum. Delivery When a food order is placed, it is slotted into a delivery date and time to be prioritized appropriately for picking. Foods are picked from the vast warehouse shelves when an order is placed and prepared to be packed into the truck for delivery. Starting in the evening, warehouse employees have picked up more than 60,000 items by the time deliveries start early the next morning. Shelf-stable frozen and fresh products are picked separately in order to maintain temperature and quality. Lettuce would likely be picked near the end of the order fulfillment to keep it fresh and cool. Foods requiring temperature control are held in a safe temperature range for the entire loading and delivery process, with multiple food orders being fulfilled at once. Logistically, it takes complex processes and highly organized workers to fill hundreds of orders with thousands of products quickly and accurately. When delivery trucks are loaded, there can be up to 20 deliveries’ worth of items, loaded strategically so that the driver has access to the pallets in the right order for their route. From there, the delivery driver follows a set route to unload deliveries in the most efficient manner. Customers who download an app can even track the route of their delivery to better estimate delivery time and coordinate shipments so the lettuce makes it into the coolers in a timely manner. Many food service managers know their regular delivery drivers by name and maintain a friendly relationship with them. With fresh food deliveries happening all week long, customers can rest assured that every effort is made to bring fresh wholesome foods, like healthy and delicious lettuce, to supply senior living kitchens.  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. SPONSORED CONTENT A Day in the Life of Your Produce By Jen Bruning, MS, RDN, LDN, Incite Strategic Partners

The Oregon Caregiver SPRING/SUMMER 2023 www.ohca.com 18 SPONSORED CONTENT Maintaining the facilities and grounds of a care facility is crucial for ensuring the safety and wellbeing of the patients and staff within. As we have all experienced in one way or another, a day in the life of a maintenance worker in a healthcare facility is full of challenges and responsibilities, as they are responsible for repairing and maintaining equipment, conducting routine inspections, and ensuring that the facility is clean and safe. This means any unforeseen event, like major property damage, can be frightening and overwhelming. However, experienced maintenance staff members or outside contractors are prepared to handle these situations and ensure residents are minimally impacted. In the disaster restoration industry, we have seen it all. Crises can occur in any commercial building at any time and, unfortunately, our care facilities are no exception. Here are some examples of scenarios that have needed quick action. Flooding Water damage can cause significant harm to an assisted living facility. If a pipe bursts or a natural disaster causes flooding, it can jeopardize the safety of residents and employees, potentially causing respiratory and other health issues. Fire Fires can occur due to electrical problems, cooking accidents in the back of the building, or just a simple mistake like forgetting to blow out a candle in a resident’s room. Fire damage can be devastating, but even just the smoke from a small accident can cause some extreme exposures to the health of residents in a facility. Mold Mold can grow quickly from a small unnoticeable leak and can cause sometimes significant respiratory issues, especially in seniors or those with pre-existing health problems. We see these rapid growth situations in our care facilities as the temperatures are higher than normal and the humid Oregon climate makes it the perfect environment for mold growth. What to Expect Throughout the Restoration Process When a crisis occurs, a restoration company is often called in to assess the damage and begin emergency stabilization services to stop any further damage from occurring. Insider Tip When selecting an emergency restoration company, ensure the company also does the full “buildback” or general construction portion of the project that must be completed immediately after the mitigation/remediation services. This makes the project much smoother and more efficient in getting the staff and residents back to their normal pre-loss routines. Assessment/Inspection The first step is to assess the damage and determine the extent of the damage caused by the source. A technician will inspect the area where the issue was noticed as well as any adjoining areas (crawlspace, attic, rooms that share interior walls); document the damage through written sketches and photos; and provide a detailed report of the findings. Containment In many situations, it’s essential to set up containment chambers in the areas that are affected so technicians are able to reduce the spread of airborne contaminants and mold spores to other areas of the building. In care facilities where there may be immune and respiratory deficiencies, this is an extra precaution that keeps the residence safe and comfortable. Remediation and Drying This is the most invasive part of the project, which usually involves removing damaged materials, such as flooring, drywall, and insulation. Immediately after demolition, specialized equipment is set to control the spread of debris and allergens, as well as to dry the affected area. Restoration With a full services restoration company, the repairs team will be quickly in tow after the mitigation/remediation and drying services. This final part of the A Day in the Life of a Restoration Process in Long Term Care By Kari Day, Senior Director of Strategy, Summit Cleaning & Restoration