The Centers for Medicare & Medicaid Services (CMS) recently released an updated Hand in Hand Series for Nursing Homes, a training series focused on caring for residents with dementia and on preventing abuse. While CMS isn’t currently offering continuing education units (CEUs) for Hand in Hand, the agency recommends—but does not mandate—that providers use Hand in Hand to fulfill federal requirements for training all nursing home staff about dementia management and resident abuse prevention, said CMS officials at the Oct. 11 Skilled Nursing Facility/Long-term Care Open Door Forum (ODF).

“Federal law requires that nurse aides complete in-service training on dementia management and resident abuse prevention,” they explained. “Additionally, facilities must now provide dementia management and resident abuse prevention training to all facility staff, contractors, and volunteers.”

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. 

The PDF file labeled “MDS3.0RAIManualv1.16R.Errata.October.1.2018,” available below, contains revisions to pages in Chapter 3, Section J, of the MDS 3.0 RAI Manual v1.16R, that amend the criteria for Major Surgery and correct the associated examples.

Changed manual pages are marked with the footer “October 2018 (R).” 

The errata document begins with a table that lists all identified revisions and the pages to which they have been applied. Following the table are the actual corrected replacement pages for insertion into the printed manual. 

This final rule updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2019. This final rule also replaces the existing case-mix classification methodology, the Resource Utilization Groups, Version IV (RUG-IV) model, with a revised case-mix methodology called the Patient-Driven Payment Model (PDPM) beginning on October 1, 2019. The rule finalizes revisions to the regulation text that describes a beneficiary’s SNF “resident” status under the consolidated billing provision and the required content of the SNF level of care certification. The rule also finalizes updates to the SNF Quality Reporting Program (QRP) and the Skilled Nursing Facility ValueBased Purchasing (VBP) Program. 

Correction Notice SUMMARY: This document corrects technical errors in the final rule that appeared in the August 8, 2018 Federal Register (83 FR 39162) entitled “Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities (SNF) Final Rule for FY 2019, SNF Value-Based Purchasing Program, and SNF Quality Reporting Program.” DATES: The corrections in this document are effective October 1, 2018 .

Health care personnel working in long-term care settings, the majority of whom work as assistants or aides, have lower influenza vaccination coverage than do health care personnel working in all other health care settings, which puts the elderly in long-term settings at increased risk for severe complications for influenza. Implementing workplace strategies shown to improve vaccination coverage among health care personnel, including vaccination requirements and active promotion of on-site vaccinations at no cost, can help ensure health care personnel and patients are protected against influenza. 

About 15,600 nursing homes participate in Medicare and Medicaid. To help ensure that residents receive quality care, the Centers for Medicare & Medicaid Services (CMS) collect data (such as nurse staffing levels) on these nursing homes.

We testified that CMS's data showed mixed results—they showed an increase in consumer complaints along with improvements in the quality of care. We found that data issues (e.g., different states using different data collection methods) complicated CMS’s ability to assess whether the results reflected actual changes.

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 question and answer (Q+A) for the July 31/August 1, 2018, Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Training is now available.