• Potential Trend Alert: SNFs Sued re: Alleged False Five-Star Data for Nurse Staffing (3/21)

    Friday, March 19, 2021 | OIG

    Note from staff: This lawsuit, brought by the now director of the U.S. Department of Health and Human Services, not only alleges problems with the discharge process, it alleges that SNFs submitted false data to Five-Star, specifically nurse staffing data.

     

    Attorney General Becerra Sues Nursing Home Chain for Misrepresenting its Quality of Care and Putting Seniors, People with Disabilities at Risk

    Today's lawsuit pertains to Brookdale's current and former California skilled nursing facilities located in the cities of Bakersfield, Camarillo, Carlsbad, Northridge, Rancho Mirage, San Diego, San Dimas, San Juan Capistrano, Santa Rosa, and Yorba Linda 

    March 15, 2021

    SACRAMENTO – California Attorney General Xavier Becerra today joined a coalition of District and City Attorneys, led by Kern County District Attorney Cynthia Zimmer, in filing a lawsuit against Tennessee-based Brookdale Senior Living, Inc. (Brookdale), the nation’s largest senior living operator. Today’s lawsuit, which concerns Brookdale’s ten California skilled nursing facilities, alleges that Brookdale ignored laws that protect patients' safety when they are discharged from a facility. The lawsuit also alleges that Brookdale gave false information to the Centers for Medicare & Medicaid (CMS), information which CMS uses to award “star ratings” to skilled nursing facilities so that consumers can choose a quality facility. By lying to CMS, Brookdale fraudulently increased its star rating in several categories to attract prospective patients and their families.

    The lawsuit alleges that Brookdale failed to properly notify its patients and families of transfers and discharges. Skilled nursing facilities are required to give notice of transfer or discharge at least 30 days in advance, or as soon as practicable. Brookdale failed to timely provide this required notice to its patients, with a copy to the local ombudsmen. Brookdale also failed to properly prepare its patients for transfer or discharge. As a result of these actions, Brookdale endangered the health of its patients and also left families scrambling to find other places to care for their loved ones.

    The lawsuit also alleges that Brookdale misrepresented the quality of its care to the public by reporting false information to CMS. As a means of helping the public to choose a skilled nursing facility, CMS rates facilities on several quality measures on a scale of one to five stars, which are then posted to the CMS website. The lawsuit alleges that Brookdale over-reported its nursing staffing hours to CMS, and by doing so, Brookdale was awarded undeserved four-and five-star ratings. In the lawsuit, the coalition argues that by engaging in these unfair business practices, Brookdale violated both the Unfair Competition Law and False Advertising Law.

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  • Staffing During the COVID-19 Pandemic: A Guide for Nursing Home Leaders (2/21)

    Tuesday, February 23, 2021 | IHI
    A resource guide, written by and for directors of nursing, administrators, and other nursing home leaders, outlines steps to reduce or eliminate urgent staff shortages, particularly shortages of direct care workers. This guide is from the Institute for Healthcare Improvement (IHI) and Project ECHO, a project of the Agency for Healthcare Research and Quality (AHRQ).
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  • Emergency Preparedness Report: Identifying and Overcoming Healthcare Communications Vulnerabilities (2/21)

    Monday, February 22, 2021 | ASPR TRACIE

    ASPR TRACIE Emergency Preparedness Report: Identifying and Overcoming Healthcare Communications Vulnerabilities: Nashville, TN

    While the Christmas morning recreational vehicle blast outside the AT&T transmission facility in Nashville did not cause a mass fatality incident, it significantly impacted healthcare communications throughout the region. This article describes the impacts, lessons learned, strengths, and challenges faced by two professionals with different perspectives of the Nashville healthcare system.

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  • Center for Medicare Advocacy Offers Nursing Home COVID-19 Lessons Learned and Policy Recommendations (2/21)

    Monday, February 22, 2021 | CMA

    The Center for Medicare Advocacy released a new report – Geography Is Not Destiny: Protecting Nursing Home Residents from the Next Pandemic – which explores facilities’ responses to the coronavirus crisis and examines how residents’ deaths were not “inevitable”, as some have claimed. The report contends that COVID-19 exploited and exacerbated long-standing issues, such as staffing, infection control, and management problems, that existed for decades in the long-term care industry.

    As our nation’s nursing homes continue to reel from the unprecedented toll that COVID-19 has taken, questions remain about how many deaths could have been avoided, and – crucially – what can be done to save lives moving forward to prevent a similar catastrophe in the future. Nationwide, 36% of COVID-related deaths have occurred in long-term care facilities (and in some states that figure jumps to over 60%). These statistics are even more shocking considering that less than 1% of the nation’s population live in these facilities.

     “The wrath of COVID-19 in our nursing homes was felt, in large part, because we as a nation have not prioritized fixing these issues,” states Cinnamon St. John, the report’s author – who is also the Center’s Health and Aging Policy Fellow and Associate Director of NYU Rory Meyers’ Hartford Institute of Geriatric Nursing. “COVID-19 will very likely not be the last pandemic we experience in our lifetimes. If we don’t address these issues now, will see these mass casualties again. The good news is that we know more now. The lessons are clear. But we must act. The currency is lives – lives lost, or lives saved,” she added

    The report:

    ·         Analyzes and challenges the assertion that “Geography is Destiny” as the prevailing theory of nursing home transmission (concluding “a facility’s location does not equate to a facility’s fate”)

    ·         Identifies lessons learned for nursing homes

    ·         Provides specific policy recommendations for change

    The report also examines both the challenges and successes of nursing home administrators who have been combatting COVID-19 on a daily basis. “You can either panic during the pandemic or you can be prepared during the pandemic. It’s better to be prepared,” says Reverend Derrick DeWitt, Director and CFO of the Maryland Baptist Aged Home. His nursing home, with about a 90% Medicaid resident population, has remarkably remained COVID-free to this day.

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  • Emergency Preparedness: Healthcare Cybersecurity Readiness and Response (2/21)

    Sunday, February 21, 2021 | ASPR TRACIE
    As part of our nation’s critical infrastructure, healthcare facilities large and small must be proactive and move quickly to protect themselves from cyberattacks that could directly impact the health and safety of patients and the community at large. According to medical health experts experienced in cybersecurity preparedness, cyberattacks are identified as the top threat in many healthcare systems’ annual Hazard Vulnerable Analyses (HVA).  Healthcare System Cybersecurity: Readiness and Response Considerations addresses this threat.
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  • LTCSP Survey Resources: Surveyor Tools Updated (2/21)

    Sunday, February 7, 2021 | CMS

    This ZIP file contains resources for surveyors conducting initial surveys under the Long-term Care Survey Process (LTCSP).

     

     

    02/05/2021 Survey Resource folder update: 

     

    LTCSP Procedure Guide

    • Expansion of complaints/FRIs in LTCSP during recertification survey

    LTCSP 11.9.5 User Guide

    • Expansion of complaints/FRIs in LTCSP during recertification survey

     

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  • LTCSP Procedure Guide - Updated (2/21)

    Sunday, February 7, 2021 | CMS

    The LTCSP Procedure Guide provides instruction on the procedural and software steps necessary for completing the Long-term Care Survey Process. Surveyors use the Procedure Guide for all standard surveys of SNFs and NFs, whether freestanding, distinct parts, or dually participating. The LTCSP steps are organized into seven parts: 1) offsite preparation; 2) facility entrance; 3) initial pool process; 4) sample selection; 5) investigation; 6) ongoing and other survey activities; and 7) potential citations.

    2/5 update

    1. LTCSP Procedure Guide: Expansion of complaints/FRIs in LTCSP during recertification survey

     

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  • Check Your Data: Updated Data Process Will Impact CASPER/SNF QRP Provider Demographic Data (2/21)

    Saturday, February 6, 2021 | QTSO

    CMS will be transitioning to a new data source for a provider’s demographic data for all five Post-Acute Care (PAC) provider types (Skilled Nursing Facilities / Nursing Facilities (SNF/NFs), Home Health Agencies (HHAs), Inpatient Rehabilitation Facilities (IRFs), Long-Term Care Hospitals (LTCHs) and Hospices).  These demographic data include such items as the provider name, provider-mailing address, provider physical address, State, ZIP Code, etc.  These provider demographic data are displayed on the Provider and Quality Measure reports generated from the Quality Improvement and Evaluation System (QIES) Certification and Survey Provider Enhanced Reports (CASPER) Reporting application for SNF/NF and Hospice providers and reports generated from Internet Quality Improvement and Evaluation System (iQIES) for HHA, IRF, and LTCH providers.  Additionally these same demographic data are displayed on the public reporting websites such as the Provider Data Catalog (PDC).

    Historically provider demographic data have been maintained in the Automated Survey Processing Environment or ASPEN software; however, CMS will be transitioning to use the demographic information from Provider Enrollment, Chain and Ownership System (PECOS).  While this transition is underway, a final date when all demographic data will be obtained from PECOS has not been identified.  During this transition, all PAC providers will be responsible to ensure their latest demographic data are updated and available in both the ASPEN and PECOS systems. 

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  • CMS Online Platform for Submissions of 1135 Waiver Requests and Inquiries (1/21)

    Sunday, January 10, 2021 | CMS

    • New Web Platform for 1135 Waivers and Inquiries – The Centers for Medicare & Medicaid Services (CMS) is announcing a new web-based tool to assist Medicare/Medicaid-participating providers and suppliers in submission of 1135 Waiver requests and inquiries. With very limited exception, the new web system should be used for all 1135 waiver requests and/or PHE-related inquiries submitted on or after January 11, 2021.

    • Waiver requests related to Physician Self-Referral (Stark Law) should not be submitted via the new web portal. For these requests, please visit:https://www.cms.gov/Medicare/Fraud-and-Abuse/PhysicianSelfReferral/Spotlightfor additional information.

    • This policy memorandum outlines the new changes to submission of 1135 Waiver requests/inquiries as well as resources available to providers and suppliers during the current COVID-19 Public Health Emergency (PHE) and future emergency events.

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  • LTCSP Survey Pathways Updated (12/20)

    Sunday, December 13, 2020 | CMS
    Available survey pathways include the following:

    • SNF Beneficiary Protection Notification Review
    • Dining Observation
    • Infection Prevention, Control & Immunizations.  Note: 12/10/2020 update for this pathway.
    • Kitchen Observation
    • Medication Administration Observation
    • Resident Council Interview
    • Quality Assessment and Assurance (QAA) and Quality Assurance and Performance Improvement (QAPI) Plan Review
    • Abuse Critical Element Pathway
    • Environmental Observations
    • Sufficient and Competent Nurse Staffing Review
    • Personal Funds Review
    • Activities Critical Element Pathway
    • Activities of Daily Living (ADL) Critical Element Pathway
    • Behavioral and Emotional Status Critical Element Pathway
    • Urinary Catheter or Urinary Tract Infection Critical Element Pathway
    • Communication and Sensory Problems (Includes Hearing and Vision) Critical Element Pathway
    • Dental Status and Services Critical Element Pathway
    • Dialysis Critical Element Pathway
    • General Critical Element Pathway
    • Hospice and End of Life Care and Services Critical Element Pathway
    • Death Critical Element Pathway
    • Nutrition Critical Element Pathway
    • Pain Recognition and Management Critical Element Pathway
    • Physical Restraints Critical Element Pathway
    • Pressure Ulcer/Injury Critical Element Pathway
    • Specialized Rehabilitative or Restorative Services Critical Element Pathway
    • Respiratory Care Critical Element Pathway
    • Unnecessary Medications, Psychotropic Medications, and Medication Regimen Review Critical Element Pathway
    • Medication Storage and Labeling
    • Preadmission Screening and Resident Review Critical Element Pathway
    • Extended Survey
    • Hydration Critical Element Pathway
    • Tube Feeding Status Critical Element Pathway
    • Positioning, Mobility & Range of Motion (ROMADL) Critical Element Pathway
    • Hospitalization Critical Element Pathway
    • Bladder or Bowel Incontinence Critical Element Pathway
    • Accidents Critical Element Pathway
    • Neglect Critical Element Pathway
    • Resident Assessment Critical Element Pathway
    • Discharge Critical Element Pathway
    • Dementia Care Critical Element Pathway

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