Lets Talk NORS Improved Tools for Storm Tracking

Let’s Talk NORS Improved Tools for Storm Tracking & Current Charting-From ORT to OAAPS Louise Ryan, MPA Ombudsman Program Specialist Maria Greene, Consultant November 4, 2019

Agenda • Background • What is Changing • ORT? OAAPS? What do I need to know? • Not about “weeds” • Brief overview of OAAPS • Resources Available • Questions 2

Quick check-in • How many of you have attended the National Ombudsman Resource Center (NORC) sessions on the revised NORS data collection? – All? – Some? 3

Alphabet Soup • NORS - National Ombudsman Reporting System • ORT- Ombudsman Reporting Tool • OAAPS – Older Americans Act Performance System 4

Background The Older Americans Act (OAA) and federal Ombudsman program rule require the Ombudsman to independently develop and provide a final annual report to ACL. The report that states submit to fulfill this requirement is the National Ombudsman Reporting System (NORS) 5

Older Americans Act Requirements* The State agency shall establish a statewide uniform reporting system to – • collect and analyze data relating to complaints and conditions in longterm care facilities and to residents for the purpose of identifying and resolving significant problems; and • submit the data, on a regular basis, to— (A) the agency of the State responsible for licensing or certifying long-term care facilities in the State; (B) other State and Federal entities that the Ombudsman determines to be appropriate; (C) the Assistant Secretary; and (D) the National Ombudsman Resource Center established in section 202(a)(21). *OAA Section 712 (c) Reporting System

National Ombudsman Reporting System (NORS) • Data elements that LTC Ombudsmen are required to collect Sec 712(h) (1)-(3)(b) • Cases, Complaints • Types of Complaints and outcome (resolution) • Consultation • Funds Expended and sources • Staff FTE • Numbers of Volunteers and hours • Activities: Training, noncomplaint visits, resident and family councils • Systems issues & Legal (narrative)

How do State Ombudsman Programs… report their NORS data to ACL? q Currently in the Ombudsman Reporting Tool (ORT) q Last report in ORT is January 2020 Next up: Older Americans Act Performance System (OAAPS) § This is the new software that state Ombudsman programs will use to submit NORS data 8

When do changes occur? • October 1, 2019 (FFY 2020) – New NORS data collection begins – Meaning – new codes and specific activity information – OAAPS is also live and available for practice • First report due to ACL – January 31, 2021 (in OAAPS) 9

National Ombudsman Reporting System (NORS) üNORS is not going away – it is changing üAs an every day or routine data collector your focus is NORS…Cases, complaints, activities… documenting the Important work that you do! 10

Current and Revised NORS Instructions and Complaint Codes https: //ltcombudsman. org/omb_support/nors Revised NORS Tables https: //ltcombudsman. org/omb_support/nors/revised-nors-data-collection

New NORS • The Tables replace the current NORS form and Instructions. • The Tables include “Examples and Reporting Tips” which provides instruction on how to code complaints and other activities. • The National Ombudsman Resource Center (NORC) has created training on how to interpret the new codes. https: //ltcombudsman. org/omb_support/nors/revised-nors-data-collection 12

New NORS • New NORS data collection requires Ombudsman programs to: – Report case level instead of aggregated data to ACL – Provide data to ACL that had not been asked for previously 13

Revised NORS Tables The revised NORS has three distinct Data Collection Tables. Table 1 – Case and complaint codes, values and definitions Table 2 – Complaint Codes and Definitions Table 3 – State Program Information

Case Level Data Replaces Aggregated Data • Aggregated data is information that is gathered and expressed in a summary form. • Under the current NORS, ACL asks Ombudsman programs to report aggregated data. For example, Ombudsmen report the total number of verified complaints. • Although ACL knows the total number of verified complaints, it can not determine how many were verified abuse complaints. • Since New NORS requires Ombudsman programs to report data about each case, ACL will be able to determine the number of verified abuse complaints. 15

Table 1 Highlights Case and complaint codes, values and definitions • • Date case & complaint opened and closed Facility or setting Complainant Complaints (one or more) Perpetrator Referral agency Verification • Disposition

Why was perpetrator added? • In the current NORS, there is sometimes confusion and miscoding because there are duplicate codes that describe abuse. • This addition will: – provide ACL with a better understanding of the types of abuse, neglect, and exploitation and the perpetrator; – increase the information available about abuse; and – improve the ability to analyze the data.

Type of Facility or Setting • Nursing Facility • Residential Care Community (formerly Board & Care) – You may call it “assisted living” • Other Setting (formerly Other) – Home care, managed care, adult day health, etc.

Table 2 Highlights Complaint Codes and Definitions • 59 complaint codes • Complaint Code Categories A-L – – Category A: complaints about abuse and you must select a perpetrator Categories B – J: complaints against the facility Category K: complaints against other programs and agencies Category L: complaints against others not associated with the facility • Crosswalk B: Complaint Codes – Old NORS to Revised NORS

Table 2 – Complaint Data Example Abuse, Gross Neglect, Exploitation (Code A) – Revised NORS A 01 Physical Abuse A 02 Sexual Abuse A 03 Psychological Abuse A 04 Financial Exploitation A 05 Gross Neglect A 6 and A 7 no longer exist in the revised NORS A 6 Resident-to-resident physical or sexual abuse. (Identify the type of resident to resident abuse by selecting appropriate code(s) A 01 -A 04 with resident as suspected perpetrator. ) A 7 Not Used

Table 3 Highlights State Program Information A. Complaint Example B. Systems Issues C. Organizational Structure D. Staff and volunteers E. Conflicts of Interest F. Funds expended G. Facilities and beds H. Ombudsman program activities 21

H - Ombudsman program activities • • Ombudsman Program Training of Facility Staff (NF and RCC) Information and Assistance (facility and individuals) Visits Survey Participation Resident Council Participation Family Council Participation Community Education

Changes in Ombudsman Program Activities • Ombudsman program training • Simplified - though your State Ombudsman may want you to continue to report training. • Activities • Reported by facility type (NF or RCC), i. e. facility staff training, survey, work with resident or family councils, information and assistance, etc. • Visits • Report both complaint related visits and routine (or non-complaint) visits.

Why Change? • Why change NORS and why switch from ORT to OAAPS? – Enhance ACL’s ability to understand LTCO program operations – Help ACL better understand the experience of residents – Reduce reporting errors – Streamline reporting process for Ombudsman programs – Encourage consistency among states 24

I miss or I want other codes • Ask your state Ombudsman if they are willing to add in additional complaint codes. – Some states like to have an Information and Assistance topic – Or training of facility staff topic. • States can have more data elements – just need to crosswalk to new NORS where appropriate. 25

Can ACL Edit the NORS Tables? • ACL convened a “NORS Next” workgroup to develop and provided feedback for the revised NORS. • Tables went through the Paper Work Reduction Act (PRA) Clearance process through the Office of Management and Budget (OMB) – – an initial 60 -day comment period ACL made revisions in response to comments then another OMB 30 -day comment period final review and final OMB approval • Future changes will have to go through the same process – tables expire April 30, 2021 • Collecting recommendations for future changes based on input from webinars and programs

What about past NORS data? • Lives on the Aging Integrated Data Base (AGID) – https: //agid. acl. gov/ • OAAPS will contain 10 years of past data that has been crosswalked to the new codes. 27

OAAPS – Quick Tour • Who has Access? – State Ombudsmen – Other staff at discretion of State Ombudsman § Different use levels, i. e. view only, access some reports – ACL Staff 28

OAAPS Home Page 29

OAAPS Resources Page • Reference Materials User Guide Quick Reference Guides • Recorded Training • FAQs 30

OAAPS Resources Page • Technical Documents • • Introduction: NORS Revisions Table 1: Case Levels Table 2: Complaint Codes Table 3: Program Information Crosswalk A: NORS Overview Crosswalk B: Complaint Codes (Old NORS to Revised NORS) Upload files 31

Analysis Reports 32

Report Example A. Abuse, Gross Neglect, Exploitation: Complaint Analysis by Complaint Code Complaint code Total per code Complaint Verification Complaint Disposition s Complaints Referred to Verified Not Verified Resolved/ Partially Resolved Withdrawn Not Resolved Licensing, Certification APS All Settings A. Abuse, Gross Neglect, Exploitation Total A 01. Abuse: physical A 02. Abuse: sexual A 03. Abuse: psychological A 04. Financial exploitation A 05. Gross neglect Perpetrator Law P&A Enforcement Legal Services None Other Facility Staff, Another Family, Other Facility Resident Responsible Rep, Friend 33

Pilot Testing • Pilot training and testing occurred in July 2018 – No major problems found during pilot – Feedback on test materials and webinars was very helpful – A lot of positives! § I like the state logo on the Dashboard. § The appearance is very clean and easy to navigate. § I used the Cases and Complaints Upload Instructions and found them to be helpful and easy to understand. § The view data feature works well and also serves as a way to make sure the file was uploaded. 34

Work with Vendors & State IT Staff • ACL and contractor ICF held meetings with vendors and state IT staff (for state developed software) • They were invited to pilot to better learn the system • They have received all technical documents • We have encouraged early communication between the Ombudsman program and their vendor or state IT developer • ACL is available to answer questions 35

Next Steps • The Ombudsman Resource Center continues to provide NORS training including a FAQ Webinar held on September 24 • They are developing an “on-demand” interactive NORS training • Keep working on the transition from old to new! 36

Questions? Contact: louise. ryan@acl. hhs. gov 37