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Arkansas Culture Change: Using Civil Money Penalties for Green House Development


Presented at the National Academy for State Health Policy's 20th Annual State Health Policy Conference in Denver, Colorado. Author: Carol Shockley

Presented at the National Academy for State Health Policy's 20th Annual State Health Policy Conference in Denver, Colorado. Author: Carol Shockley

Published in Business , Health & Medicine
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  • 1. Arkansas Culture Change Using Civil Money Penalties for Green House Development
  • 2. Arkansas Culture Change Like all states, Arkansas has  recognized the need for culture change. This change is being driven, as are  many of society’s changes, by the “Baby Boomer” generation.
  • 3. Arkansas Culture Change Baby Boomers demand independence.  In long-term care, options include  home- and community-based services, as well as more home-like facility services. When home-based care is not  possible, boomers want home-like facility.
  • 4. Arkansas Culture Change Two preliminary questions when states  consider culture change: What are the most beneficial changes?  Where does the funding for culture  changes come from?
  • 5. Arkansas Culture Change Most promising culture change trend is  the Green House model. Green House physical model  differentiates it from other types of culture change.
  • 6. Arkansas Culture Change Physical design promotes home-like  environment, and Reinforces the core principles that  embodies all culture change and Eden principles—recognizing the resident as a person rather than a patient; providing them with an environment in which the resident may thrive rather than just survive; offering care with dignity.
  • 7. Arkansas Culture Change The Centers for Medicare and Medicaid  Services (CMS) has long urged states to utilize their Civil Money Penalty (CMP) funds for the benefit of residents. The law controlling CMPs in Arkansas  was very specific – allowed fund to grow with almost no expenditures.
  • 8. Arkansas Culture Change Use CMP fund as grants to limited  applicants who demonstrated the desire to seriously consider a Green House facility. Use CMP funds to off-set “exceptional”  costs, such as specialized staff training, architects with expertise in Green Houses, higher construction costs, etc.
  • 9. Arkansas Culture Change Intent of grants to remove initial  barriers to Green Houses. Hope is that operators find ways to  operate the facilities under the current state reimbursement methodology, with anticipated occupancies at or near 100%.
  • 10. Arkansas Culture Change Tasks:  Amend state law to permit access to  CMP funds. Amend state law to permit “universal  workers” in Green House facilities. Amend regulations to permit Green  House facilities. Obtain “buy-in” from legislative  leaders, industry representatives, etc.
  • 11. Arkansas Culture Change CMP Bill – Act 193 of 2007  ftp://www.arkleg.state.ar.us/acts/200  7/public/Act193.pdf
  • 12. Arkansas Culture Change Staffing Bill – Act 192 of 2007  ftp://www.arkleg.state.ar.us/acts/200  7/public/Act192.pdf
  • 13. Arkansas Culture Change Most difficult task is re-writing  regulations. Arkansas’ regulations were antiquated.  Regulations did not afford traditional  facilities the ability to implement culture change.
  • 14. Arkansas Culture Change Using federal regulations as the base  for new regulations. Add state-specific regulations, such as  licensure, staffing, and similar requirements. State-specific sections are examined  to see whether they act as a barrier to culture change; if so, they are either amended or eliminated.
  • 15. Arkansas Culture Change The result, it is hoped, will be  regulations that not only permit Green Houses to operate in Arkansas, but to both permit and encourage traditional facilities to adopt concepts and practices of culture change.
  • 16. Arkansas Culture Change Real culture change requires  considerable time and effort. Ultimate benefit is to residents.  The benefit to residents is the real  purpose of culture change.
  • 17. Carol Shockley, Director Office of Long Term Care Arkansas Department of Human Services 501-682-8485 carol.shockley@arkansas.gov