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The MDS-based CASPER Quality Measures (QMs) that are posted on Nursing Home Compare, some of which drive the QM domain in the Five-Star Quality Rating System, are a frequent source of headaches for directors of nursing services (DNSs). “Everyone wants Five-Stars in the overall composite rating to attract clients, but adverse events often linger on the CASPER QMs much longer than many DNSs and administrators think they will,” says Carol Maher, RN-BC, RAC-MT, CPC, director of education for Hansen, Hunter & Co. PC in Vancouver, WA.
DNSs should have a basic idea of how long adverse events will impact the CASPER QMs, but that shouldn’t be the primary concern, suggests Maher. “The QMs will impact the overall Five-Star rating, but they have a lesser impact than the survey/health inspection and staffing domains. You must have Five-Stars in your QM domain to be able to add a star to your overall rating, and even Five-Stars in the QMs won’t help if your health inspection rating is one star and you’ve already added a star via the staffing domain. In addition, you have to have only one star in the QM domain to negatively affect your overall rating.” Note: For more information, see the “Overall Nursing Home Rating (Composite Measure)” section of the Nursing Home Compare Five-Star Quality Rating System Technical Users’ Guide.
So the CASPER QMs are most important as a tool that DNSs can use to identify opportunities for improvement, stresses Maher. “If you focus on providing person-centered care and improving care, you will get to five stars.”
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:
It’s that time of year. The turkey has been carved and eaten, and the holiday decorations are beginning to appear. To most people, that means holiday season has officially arrived.
But to directors of nursing services (DNSs) across the country, it means something else entirely: the full implementation of Phase 2 of the Mega Rule—and with it, the new survey process to monitor compliance with infection control and prevention standards.
Is your facility ready for the surveyors? Here's how to get started to make sure that you meet the infection prevention requirements, and enjoy your holidays too.
Creating the comprehensive person-centered care plan required by the Final Rule revising the Medicare/Medicaid conditions of participation (aka the Mega Rule) is different than creating a traditional comprehensive care plan, says Anna Ortigara, RN, MS, FAAN, organizational change consultant for the Paraprofessional Health Institute (PHI) in the Bronx, NY. “Incorporatinmegag person-centered care into the care plan requires a shift in the way you look at what your team does.”
Here are the key steps that directors of nursing services (DNSs) and their interdisciplinary teams should take to ensure the end result of a truly person-centered comprehensive care plan that balances a resident’s rights with their clinical care needs:
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