You Are Here:Home/Resources/DNS Navigator/DNS Navigator Details
Historically, many providers have treated the MDS and the Resident Assessment Instrument (RAI) process as a silo of government-mandated busywork. That’s always been a problem because, since day 1, the primary purpose of the MDS has been to identify resident care problems that are addressed in an individualized care plan. However, the footprints of the MDS are now carved deep into multiple facets of facility life, including:
· The Medicare Part A Skilled Nursing Facility Prospective Payment System (SNF PPS);
· Some Medicare Advantage payment systems;
· Some Medicaid payment systems;
· The MDS-based quality measures (QMs) that are publicly reported on Nursing Home Compare and used in the Five Star Quality Rating System; and
· The MDS-based QMs that will be publicly reported under the Skilled Nursing Facility Quality Reporting Program (SNF QRP) beginning in October 2018 assuming ongoing data issues are resolved timely. Note: SNFs also must meet an MDS-based reporting threshold under the SNF QRP to avoid a SNF PPS payment penalty each fiscal year.
Last but not least, the new Long-term Care Survey Process (LTCSP) makes sure that surveyors have MDS-based clinical indicators to guide their investigations from the moment they walk in the door, according to the LTCSP Procedure Guide.
In his children’s book Happy Birthday to You, Dr. Seuss eloquently wrote, “Today YOU are YOU, that is truer than true. There is no one alive who is youer than YOU.” The book was intended to encourage children to celebrate who they are and the ability they have to shape the course of their lives. Those same words can also be powerful in the life of a nurse leader. The long-term care environment is challenging, chaotic, and tumultuous, and that is on the good days. Changes in regulations, staff, processes, and census come fast. Nurse leaders need to celebrate who they are and their ability to shape the course of their lives. Nurse leaders need a little love!
“There is no one alive who is youer than YOU.” So what is your YOU and how can it be used to guide your leadership role? You can begin to identify your YOU by asking the following questions:
(1) What are my strengths?
(2) What do I do well?
(3) What energizes me? and
(4) How do people say I make them feel?
After the surveyors walk through the facility door, according to the Dining Observation checklist, they will observe the first full meal to be given after their entrance, in all dining areas. (If there are fewer surveyors than dining areas, they will observe those dining areas with the most dependent residents.) There are many, many things that surveyors will be looking for; these fall into four general categories:
1. Resident dignity—Is resident choice being honored?
2. Comfortableness of dining area—Is the dining area a comfortable temperature with appropriate lighting? Are residents positioned appropriately to eat effectively?
3. Food quality—Is food palatable?
4. Safe handling—Are serving conditions sanitary and safe?
As a leader in your facility, you have the power to underscore the importance of the staff’s role in affirming the dignity of all residents at all times, including at mealtime. The best way to prepare your staff for the items on the Dining Observation checklist is to cultivate awareness of what surveyors will be looking for, and the best way to do that is to lead by example and to train staff on proper dining room protocols. Here’s a review of what to look for before the surveyors do.
The survey team’s offsite preparation is integral to the new long-term care survey process (LTCSP), says Amy Stewart, RN, RAC-MT, DNS-MT, QCP-MT, curriculum development specialist for AADNS. As part of the offsite prep, the survey team coordinator reviews and documents findings from the facility’s CASPER 3 report for patterns of repeat deficiencies, the results of the last standard survey, and complaints and facility-reported incidents since the last standard survey, as well as any facility history of abuse, federal waivers or variances for onsite review, active enforcement cases that shouldn’t be investigated, and information provided by the ombudsman.
To access this article, please login or sign up for a membership.