Creating and implementing a policy and procedure to ensure that facility staffing levels are sufficient to meet the needs of residents during an emergency, such as the COVID-19 pandemic, is an essential component of emergency preparedness—and part of the COVID-19 Focused Survey for Nursing Homes, according to the Quality, Safety, and Oversight (QSO) memo QSO-20-38-NH from the Centers for Medicare & Medicaid Services (CMS). However, the following staff management tips also can help providers prepare for another outbreak in their community:

Staying on top of COVID-19 is exhausting, acknowledges Katrina Anderson, LVN, director of skilled nursing and part-time infection preventionist for the John C. Fremont Healthcare District in Mariposa, CA, as well as a member of the Disaster Preparedness Program Advisory Council at the California Association of Health Facilities (CAHF). “Everyone is stressed out and tired, but in order to survive this, you have to stay on top of it and be diligent about obtaining the information and getting that information out to your staff as education and training.”

While a number of frameworks, guidance documents, and resources are available to help healthcare systems and stakeholders prepare for and respond to the emergence of crisis standards of care, relatively few address the unique circumstances and information needs of post-acute and long-term care (PALTC) facilities. In response to the COVID-19 pandemic, the Federal Healthcare Resilience Working Group has developed COVID-19: Considerations, Strategies, and Resources for Crisis Standards of Care in PALTC Facilities to inform changes to operations and care processes. It is intended to complement, not supplant, existing state and/or local guidance and plans for implementing crisis standards of care. Similarly, sample tools and resources are provided for illustrative purposes only and should be modified to locally adopted protocols as necessary.

In this article, AAPACN will cover the need and purpose for the Healthcare Resilience Working Group (HRWG) project, the standards of care and areas of impact, how a facility should use this document to guide decisions, and how to access this important new resource.

Surveyors arrive onsite for the annual survey and tour the facility. They overhear a nurse aide refer to a resident as “honey.” In the next room, they see a nurse completing a dressing change with the door open, exposing the resident. Both of these instances, and many others, are resident rights issues which could lead to a citation under F550.

Today, F550 is one of the top ten most cited survey deficiencies across the country. Despite being in the top ten, many of these citations result from minor issues that can be easily corrected within a facility.

This article reviews F550 requirements, discusses the top reasons for citations, and provides five quick tips to avoid future F550 citations.

The Nursing Home Reform Law of 1987 requires that every nursing home promote and protect the rights of each resident. To participate in Medicare and Medicaid, nursing homes must meet these requirements, with adherence verified during nursing home surveys.

F550 refers to resident rights, including the right to be treated with dignity and respect, in an environment that promotes quality of life. Appendix PP of the State Operations Manual says that:

The Centers for Medicare & Medicaid Services (CMS) requires that all nursing homes have an emergency preparedness program. With disasters ranging from the COVID-19 pandemic to wildfires and hurricanes seemingly around every corner, taking the following steps can help providers have a program that can stand up to any emergency:

“In 2016, CMS issued the emergency preparedness rules of participation (ROPs). Figuratively speaking, these ROPs took emergency preparedness requirements from zero to 60—they are extremely comprehensive,” says Stan Szpytek, an independent fire and life safety/disaster preparedness consultant.

“You need to conduct a hazard vulnerability assessment for your specific facility, and then you must have policies and procedures and an emergency operations plan that address every specific emergency that can occur based on that hazard vulnerability assessment,” he explains. “So the first step is knowing the specific threats and perils your facility faces and making sure that you have a compliant emergency operations plan.”