• COVID-19 Infection Prevention and Wandering: Can the Two Co-Exist?

    Tuesday, April 28, 2020 | Caralyn Davis, Staff Writer

    In the March 13 revised Quality, Safety, and Oversight (QSO) memo QSO-20-14-NH, the Centers for Medicare & Medicaid Services (CMS) advised nursing homes to restrict all visitors except for compassionate-care situations and to “cancel communal dining and all group activities, such as internal and external group activities.” Adjusting to these changes has been difficult for every nursing home resident, but social distancing is especially hard for residents with dementia who wander and are eased by group activities.

     

    “That’s not who these people are,” acknowledges Teepa Snow, MS, OTR/L, FAOTA, founder and CEO of Positive Approach to Care, a global dementia care services and products company based in Efland, NC. “Nurses are being asked to do the impossible with the inadequate.”

     

    While physicians and physician extenders may be willing to prescribe an antipsychotic medication as an emergency measure in an acute or emergency situation as allowed under F758 (Free From Unnecessary Psychotropic Meds/PRN Use) in Appendix PP of the State Operations Manual, giving residents with dementia antipsychotics to make them immobile not only increases their risk of adverse events, such as cerebrovascular accidents (CVA) and even death, it also increases their risk of respiratory symptoms, including shortness of breath—one of the primary symptoms of COVID-19, points out Snow. “Providers may also consider taking away wheelchairs and other mobility aids. However, doing that puts residents with dementia at greater risk for falls and fall-related injuries, potentially resulting in a trip to the emergency department where they may be exposed to SARS-CoV-2, the virus that causes COVID-19.”

     

    Instead, the goal should be to come up with strategies that make sense, balancing safety and resident needs, says Snow. “Keeping these residents in a small room is highly improbable, so you want to be ready to move forward with some element of safety. You will put residents at risk if you aren’t prepared for the reality that they will come out of their rooms.”

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  • Behavioral Health and Pharmacy Services: What the Mega-Rule Requires

    Thursday, December 8, 2016 | Caralyn Davis, Staff Writer
    Nursing homes are chomping at the bit for the Centers for Medicare & Medicaid Services (CMS) to release new interpretive guidance for surveyors in Appendix PP of the State Operations Manual to correspond with the Oct. 4, 2016, final rule updating the Medicare/Medicaid conditions of participation (CoPs) for long-term care facilities, aka the mega-rule. However, that interpretive or subregulatory guidance isn’t showing up anytime soon, said CMS officials during the Dec. 6 National Partnership to Improve Dementia Care and QAPI Call. 
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  • Q&A: If a resident ambulates against the plan of care, is this a rejection of care?

    Tuesday, September 13, 2016 | Amy Stewart DNS-MT,RAC-MT,RN,QCP-MT
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