ISDH Long Term Care Bed and Personnel Tracking System

by Katie Eller, IHCA Director of Education and Member Services

The ISDH has created a Long Term Care Bed and Personnel Tracking System that will be effective on
December 1, 2011. The ISDH has several purposes behind the implementation of tracking system. This system will be used to track available beds in long term care facilities and track key facility personnel.

The following are the purposes behind this system.

1. EMERGENCY PREPAREDNESS: The purpose behind the system is to improve state
emergency preparedness. In the case of emergencies, there is a need to know the location of
available beds in case there is a need for evacuation. This system is intended to provide reliable
current information on available nursing home beds.

The ISDH currently tracks the number of licensed and certified beds for each facility. That
information is recorded at the time of licensing and does not reflect the number of occupied beds.

The ISDH obtains a bed census at the time of a survey. Because surveys may not occur for up to
fifteen months apart, that data is not current and therefore not reliable in an emergency. It also
does not provide the detail as to type of available beds that is needed for appropriate placement
determinations.

In the mid-2000’s, the ISDH created an online system to track available hospital beds throughout
the State. That system, in partnership with the Indiana Department of Homeland Security, was
intended to provide improved information for emergency responders in emergency situations.That system was implemented and has been a valuable asset in emergency situations.

As a next preparedness step, the Centers for Medicare and Medicaid Services (CMS) included
the development of a bed tracking system for long term care facilities as one of its priorities to be
implemented by state survey agencies by July 2009. CMS developed a pilot tracking system for
that purpose but did not implement the system. In 2011, the ISDH therefore began development
of a state system.

The need for such a system can be readily demonstrated by recent emergency situations in
Indiana. In the summer of 2009, Indiana experienced significant flooding. One nursing home that
had to be totally evacuated had planned to evacuate to sister facilities. Those facilities were no
longer accessible because of the flood waters. The facility therefore needed to know where there
were nearby available beds. There was no ready source for current bed availability information
and local communications were out. Had this system existed, the ISDH could have provided the
information to local emergency responders through the state emergency communications system.

Another large facility had to evacuate nearly 200 residents. The nursing homes in the area were
at capacity so there was a need to find appropriate beds in surrounding counties. There again
was no ready source for current bed availability information. Because phone lines were
accessible, the ISDH wound up calling facilities to determine bed availability but that resulted in
delays in getting residents placed. The ISDH also learned that there was a need to know not only
the availability of a bed but the classification and purpose of the bed.

Earthquakes, tornadoes, and flooding are all realistic potential emergency situations in Indiana.
The ISDH believes that reliable bed tracking data is essential to improving the state’s emergency
preparedness and response capacity. This new bed tracking system has been designed to meet
those emergency preparedness needs.

2. FACILITY CLOSINGS AND ROUTINE PLACEMENTS: One of the challenges faced by families, facilities, and the State is the appropriate placement of residents. When families or State
Ombudsman are trying to find available beds in an area, they often spend lots of time calling
facilities trying to identify available beds. Even more critical is when a facility is closing and there
is a need to place a large number of residents. The bed tracking system is intended to be an
efficient resource to assist in the appropriate placement of residents.

3. DETERMINATION OF STATE OCCUPANCY RATES: The ISDH is required to determine
nursing home occupancy rates. The Indiana General Assembly adopted statutes that refer to
nursing home occupancy rates. For instance, Indiana Code 16-28-16 states that the ISDH may
not approve the certification of new or converted comprehensive beds for participation in the state
Medicaid program unless the statewide comprehensive care bed occupancy rate is more than
ninety-five percent as calculated annually on January 1 by the ISDH. Other legislative proposals
have referred to a monthly occupancy rate by county and the legislature has requested that the
ISDH be able to provide monthly occupancy rates.

In order to implement state statutory requirements, the ISDH must be able to determine accurate
nursing home occupancy rates. At the present time, the ISDH is unable to comply with the
statute because the ISDH does not have a data source that provides occupancy on a given date.
While the ISDH collects occupancy data at the time of licensing surveys, the data does not allow
for determination of an occupancy rate on a given date because surveys may occur up to fifteen
months apart for a given facility.

The bed tracking portion of the new system will allow the ISDH to track bed occupancies on a
monthly basis in fulfillment of state statutory requirements. The database will also allow for
further study of occupancy rates by various criteria as requested by legislative studies.

4. EDUCATION AND TRAINING: The ISDH periodically provides education and training on
healthcare quality of care issues. Examples include state leadership conferences as well as the
pressure ulcer and healthcare associated infection initiatives. As part of these initiatives, the
ISDH often provides resource materials or information on educational opportunities.

The ISDH does not currently have contact information for key healthcare providers related to
topics in their area of expertise and responsibility. The result is that healthcare quality
improvement information often does not reach the relevant healthcare providers.

For example, there has been interest in developing programs to improve care coordination.
While the ISDH tracks the name of the facility medical director, we do not necessarily have
contact information for those individuals. Furthermore, the ISDH does not have any contact
information for attending physicians. With improved contact information for key healthcare
providers, the goal of the ISDH is to use this information to improve dissemination of information
to appropriate sources and create improved partnerships towards quality improvement.

5. SURVEY EFFICIENCY: The ISDH is always looking for ways to improve survey efficiency.
When the ISDH begins a survey, surveyors spend time identifying beds and key facility staff.
With the new tracking system, surveyors will have a copy of the facility’s bed census and key
staff. Surveyors will simply verify the list with the facility at the time of entrance. Surveyors often
spend time trying to identify the key staff not a part of current reporting. For instance, many
health care facilities are required to have an Alzheimer’s Director. The ISDH does not currently
track that information so having the information in the system assist surveyors in identifying
required staff and thus reduce survey time.

6. IMPROVED ACCURACY OF PERSONNEL TRACKING: Healthcare rules require facilities to
provide the ISDH with a change of the facility’s administrator, director of nursing, and medical
director. An example of a regulatory reporting requirement is 42 CFR 483.75(p). The ISDH
frequently finds that information is out of date and has not been appropriately updated. The
system is intended to improve the accuracy of tracking.

The system will be housed and accessed through the same ISDH Gateway System as the new
Survey Report System that was implemented earlier in 2011. The facility should expect to receive
an email on or about November 30 requesting the facility to submit their monthly report. The email
will be sent to the same email address used in the Survey Report System. The facility should then
log in to the system and provide the requested information. The facility will then subsequently
receive a reminder each month via email to update their data.


What Information Will be Tracked

The following available bed information will be tracked on a monthly basis:

• Facility census on last day of month
• Total bed occupancy
• Subcategories of bed availability
• Bed availability: male and female
• Bed availability: Alzheimer's Unit
• Ventilator beds available

Facilities will be asked to provide contact information for the following individuals:

• Administrator(s)
• Director(s) of Nursing
• Medical Director(s)
• Attending Physicians
• Nurse Practitioners
• Physician Assistants
• Minimum Data Set (MDS) Coordinator
• Wound Care Specialist(s)
• Alzheimer's/Dementia Unit Director(s)
• Social Services Director(s)

For More Details
For more details about the tracking system and the facility’s responsibility, please review:

ISDH LTC Advisory Letter LTC-2011-02

ISDH LTC Advisory Letter LTC-2011-02 Attachment A