In the realm of the revised survey process, an interesting F-tag has joined the list of the most frequently cited deficiencies across the country. The tag is F-842, and in case that regulatory number is not immediately familiar, it has to do with documentation: “Resident Records – Identifiable Information.”

Given our profession’s consistent focus on documentation, does that come as a surprise? It certainly did for this writer! Between January 2018 and April 2019, F-842 has been cited nearly 3,000 times, across all CMS Survey and Certification Regional Offices. In 2019 so far, there have been 250 deficiencies cited under F-842. Long-term care has long been required to maintain residents’ personal privacy and keep medical records confidential. This is not a new requirement of participation, so what is happening? Many of the citations stem from the medical record not being accurate and complete, which is a component of F-842.

Below are brief descriptions of a few of the cited deficiencies.

Effective this November 28, trauma-informed care will take center stage in the survey process for nursing facilities (NFs) and skilled nursing facilities (SNFs) as the Centers for Medicare & Medicaid Services (CMS) completes the final stage of rolling out the revised requirements for participation in Medicaid and Medicare. CMS will implement new trauma-informed care regulations under F699 (trauma-informed care), which is a quality-of-care F-tag; F659 (comprehensive care plans/qualified persons); F741 (sufficient/competent staff‐behavioral health needs); and F949 (behavioral health training).

These new or revised F-tags will come on top of two already implemented tags that address trauma—F742 (treatment/service for mental/psychosocial concerns) and F743 (no pattern of behavioral difficulties unless unavoidable)—giving surveyors a full suite of trauma-informed care tags to guide their investigations. Note: Read the Code of Federal Regulations citations that underpin the trauma-informed care requirements for each F-tag at the end of this article.

On April 24, the Centers for Medicare & Medicaid Services (CMS) made a series of changes to the Five-Star Quality Rating System on Nursing Home Compare. Now that directors of nursing services (DNSs) have that update under their belt, they can take the following steps to get a handle on the biggest surprises:

With the implementation of the Patient-Driven Payment Model (PDPM) just a few short months away, you may be asking yourself what benefits restorative nursing programs will have under the new system. PDPM will focus less on the volume of therapy minutes and more on the resident’s characteristics and diagnoses. However, SNF leadership must balance the costs of the services provided while achieving successful resident outcomes. Facility leaders may want to consider how a comprehensive restorative nursing program can help them reach these goals, given that such a program can maintain or improve a resident’s function, improve quality outcomes, and reduce costly complications such as wounds.

Despite the document being only a draft version, we are anxious to see just what the changes may be that will impact you as a nurse leader, your collaboration with the nurse assessment coordinator (NAC), and the rest of the interdisciplinary team (IDT) this fall. Let’s start at the beginning and review some of the changes that are coming your way.

Not surprisingly, the April 19 release of the fiscal year (FY) 2020 Skilled Nursing Facility Prospective Payment System (SNF PPS) Proposed Rule (CMS-1718-P) was the primary focus of officials with the Centers for Medicare & Medicaid Services (CMS) during the April 23 Skilled Nursing Facility/Long-term Care Open Door Forum (ODF). Highlights include the following:

Staffing shortages are the primary challenge facing directors of nursing services (DNSs), according to 75 percent of the DNS respondents in the 2019 AADNS Director of Nursing Services Work Study and Salary Report. In addition, 63 percent reported not having enough direct-care staff to adequately care for patients.

DNSs have traditionally been wary of using agency staff due to survey and quality-of-care concerns (e.g., studies have shown a clinically significant decrease in quality at facilities that use higher levels of agency staff). However, temporary certified nursing assistants (CNAs) can be a valuable resource to fill vacancies or open spots on the schedule so that a facility can meet patient care needs, according to Jill Snow, MBA, BSN, RN-BC, CHC, senior vice president of clinical operations at Ethica Health and Retirement Communities in Gray, GA, and vice chair of the AADNS Board of Directors.