Never Say Never from Repertoire August 2010 - Vol 18 Number 08

She never saw it coming. Tamar Abell had completed another successful state survey and, as far as she knew, her 30-year family-run nursing facility operation was doing well. Yet, three weeks following the inspection, Abell, along with her husband, brother and father, were shocked by visits from federal agents, the Office of Inspector General (OIG) and the Department of Justice. Further, Abell did not even own the facility in question. "We had an 18-month management contract on this building," she says. "It was a large urban facility and was much different from the facilities we typically owned and operated."

The Abell family felt they were "doing a service" to the surrounding community by running the facility, which served inner-city young adults with mental illnesses, she recalls. In fact, they had met with the Department of Public Health prior to assuming the management contract. But, allegations from a recently fired employee-turned-whistleblower led to a federal investigation, a federal lawsuit against the Abell's business and a 10-year ordeal for the Abell family. "To this day, [nursing home owners] tell me, "This can't happen to me. I'm a good operator,'" she says. "Well, so was I."

A long process

Following the investigation, Abell and her family were sued by the federal government under the False Claims Act and placed under a quality-of-care corporate integrity agreement (CIA). Under the agreement, federal officials monitored the company's nursing facilities for the next five years.

In order to stay open, Abell had to train all direct care workers in each of her facilities within the first 120 days of the program, and then follow up with additional training each year. "I had to train and track over 800 employees and report back to the OIG," she explains, noting that most of her facilities are located in southern Illinois, while she is based in Chicago. It was a huge undertaking, one that led Abell to develop an online training and tracking system to record who had been trained, where they had been trained and which tests they took. Ultimately, the online tracking system evolved into a new and separate business for Abell, and in 2005, she started Upstairs Solutions, which helps long-term-care facilities educate their staff to ensure regulatory compliance.

"Today, Upstairs Solutions offers 130 modules, ranging from dietary to management," she says. It's a proactive model, says Abel. "For example, the administrator of a program will get an e-mail stating who is not keeping up with [his or her] training. So, if an administrator is in Chicago, [he or she] knows what is going on at [his or her] facilities in California."

Working closely with an in-house team of clinical experts and an attorney, Abell keeps current on the constantly changing federal regulations, and she updates modules accordingly. The Abell's service includes a full suite of modules, a full management learning system, and updates to modules. "And, administrators only need one computer per 100 employees," she says.

Working with IMCO

Last May, Daytona Beach, Fla.-based IMCO formed a relationship with Upstairs Solutions. "It's an association-exclusive relationship," says Deb Bullock, IMCO's long-term-care director, IMCO (Daytona Beach, Fla.). "IMCO acts as a marketing facilitator between our members and Upstairs Solutions. Our sales reps benefit from online education and can provide [more] solutions to their customers. [In turn], they can refer their customers to Upstairs Solutions."

Nursing homes today do their best to stay on top of federal regulations, she continues. But, given how frequently they change, this can be difficult. "And, keeping up with regulations is key to providing consistent, quality care and [maintaining] high performance [levels] on surveys, which can impact a facility's reimbursement, census and turnover rate," she says. "Good employees care about their patients and want to work at five-star nursing homes.

"Sales reps are the conduit between the manufacturer and the nursing home," she continues. By providing literature and helping educate their long-term-care customers, they can do their part to keep nursing home administrators on track. Programs such as those offered by Upstairs Solutions can help, she adds.

"Change can be scary," adds Abell. "We usually are reactive, not proactive." Through Upstairs Solutions, she aims to change that.