Baseline and comprehensive care plans each have their own rules and requirements, but the common theme uniting them both is that they are the lynchpin between resident assessments and care provision, showing the interdisciplinary team (IDT) what they need to do to provide person-centered care that meets professional standards of quality for each resident. In the Long-term Care Survey Process (LTCSP), the critical element pathways guide surveyors to match up these care plans and medical record documentation with their own observations and interviews with residents/families to identify deficiencies.

In other words, directors of nursing services (DNSs) must maintain some management oversight of the care-planning process to improve resident outcomes and reduce the chances of bad survey outcomes, says Amanda Brogna, MSN, RN-BC, regional clinical director for Health Concepts in Providence, RI.

Implementing the following steps can help DNSs guide the IDT toward stronger care plans:

I recently had the opportunity to be with a group of acute care nurses who had started their nursing careers in long-term care. During our time together, I asked them, “Why did you leave long-term care?” I fully expected them to say it was for more money. To my surprise, they never mentioned money. What they did offer was a reflection on leadership: “Our leaders never listened to us.” When I further explored this statement, I heard stories about changes in staffing that were “announced” and about “sudden changes” in policies and procedures. One nurse described how the electronic medical record seemed different every time she went to work, without any warning or additional education. “They never asked for our input.” Clearly, not being heard is a problem among nurses in long-term care and is one of the factors contributing to turnover. A 2017 Gallup study identified a positive working environment, where people feel energized around the work, as  contributing to increased levels of employee satisfaction and reduced turnover. 

F689 (Free of Accident Hazards/Supervision/Devices) is now the second most-commonly cited F-tag in the long-term care survey process (LTCSP). However, it’s not just frequently cited—it often comes with a high severity level. F689 ranks as the No. 1 cited tag with a severity level of J, K, or L (immediate jeopardy) and as the second most-cited F-tag with a severity level of F or above, according to the July data available in QCOR, the Quality, Certification, and Oversight Reports site of the Centers for Medicare & Medicaid Services (CMS).

Appropriate, effective opioid use requires regular monitoring—not only pharmacological monitoring but systems checks as well. “After your interdisciplinary team has reviewed facility systems and ensured good practices are in place, it’s important to monitor: Are they working? What’s breaking down?” says Barbara Bates, RN, MSN, DNS-CT, RAC-CT, QCP, a nurse consultant and dementia care specialist based in Bergen, NY.

“For example, if a pain assessment that is supposed to be done on admission is actually done a week after admission, there needs to be a process for identifying that error and why it occurred,” explains Bates. “You have to make sure that the process happened the way you established it should. And when practices don’t work, you have to do a root-cause analysis to find out what happened so you can revise appropriately if needed.”

Taking the following steps can help DNSs implement strong monitoring and audit processes:

The top five most commonly cited F-tags in the new Long-term Care Survey Process (LTCSP) haven’t changed much since Feb. 26, when AADNS first took a look at the data available in QCOR, the Quality, Certification, and Oversight Reports site of the Centers for Medicare & Medicaid Services (CMS). F880 (Infection Prevention and Control) maintains its position as the most frequently cited new survey tag across the country. In addition. F880 is the third most-cited new F-tag with a severity level of F or above, as well as the 10th most-cited tag with a severity level of J, K, or L (immediate jeopardy).

The field of long-term care has been undergoing culture change over the past number of years.

Where previously the culture of care was centered on maintaining resident safety (often without consideration of residents’ personal preferences), now the culture emphasizes the importance of honoring resident voices and choices when it comes to their own care. The Centers for Medicare & Medicaid Services (CMS) has been consistently updating its rules and regulations to reflect this new direction.

The shift in regulatory focus to improve resident-focused care—and the improvements it has brought to residents’ experience and life quality—cannot be overlooked.

However, it has presented a previously unseen challenge for long-term care staff: