4.107 board, coding

Saturday 03/18/2023

First thing, well, 8:15, I went down to meet with Martha and David G, to go and attend the Channing House Board Retreat. This was a day at which the staff reported on various things to the Board members. It was held at the Mitchell Park Community Center, a library and event place in Palo Alto. Catered, of course, so there were lots of delicious pastries and coffee in the morning, and a nice lunch at noon.

Besides the actual 10 or 12 Board members, there were all the elected offices of the Resident Association. And because a lot of the reported items had to do with trying to implement the Strategic Plan, Martha and I were included as members of the Strategic Planning committee which took up some of my time last year. David G. was there because he is a member of the Financial Planning committee which is an adjunct of the Board. Plus about 5 staff members, about 25 people in the room.

The elements of the Strategic Plan included points like “be a workplace of choice” and “improve memory care.” A lot of the first hours were on what they have been doing in these areas. I left my packet in the car so I don’t remember all the details, but they are doing many things to retain and hire staff in a very difficult hiring climate. And the memory care is a very elaborate program based in part on the “Best Friends Approach“. This has involved lots of staff training over months, and special training to on-board new hires.

A lot of this was pretty boring, but the final presentation, where Rhonda went over not just those areas but the “improving wellness” and “improving independent living experience”, was better. Unfortunately she asked us to keep the future plans confidential. so I won’t put them in here. But some major changes are likely to come in several areas.

One area she went over was, why is Channing House not a certified Medicare provider? We are not; we don’t (can’t) bill Medicare for anything. It’s because there would be small benefit to residents, and a huge increase in oversight, inspections, and paperwork, much of it duplicating the inspections and oversight already required by the California DPH and the California OSHPD, a parallel state agency.

Why little benefit? Medicare pays for skilled nursing only as rehab following a three-day hospital stay. Stay less than 3 days? No coverage. If you do qualify, Medicare then covers the first 20 days in full, followed by a max of 80 days at $200/day. (When Rhonda read this, a board member who is an MD laughed and said he had never heard of any patient who got more than two weeks covered.)

Point being, Channing House’s SNF provides custodial care. People who need it, often go into it directly, not from the hospital, and some can stay for a year or two. So any Medicare payment for nursing costs would be small or zero. (Treatment beyond the nursing care is provided by outside doctors or specialists who do bill Medicare.)

The issues of being a health-care provider are ridiculously complicated and Martha and I agreed on the way home that the staff are doing good work in a very difficult environment, and Rhonda is a jewel.

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