AADNS News Feed

Sorting through all that is happening in LTC and then figuring out just what you need to know can be a daunting task. Luckily, we’re here to help. Our nursing experts scour through mountains of information to identify the breaking news and important updates and changes that you need to know today. Find the latest on important topics with links to resources, websites, and tools to keep you up-to date.

  • At A Glance QM, QRP, and VBP Tool

    By AADNS - January 14, 2020
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  • Census Development: Quality, Value, and Compassionate Care Converge

    By Alexis Roam, MSN, RN-BC, DNS-CT, QCP - January 08, 2020
    Directors of nursing services (DNS) may often feel like they are refereeing a boxing match, with the demands for census battling the need to ensure provision of quality care. But the boxing ring is transforming into an entirely different arena, one where quality of care must be the ultimate champion. The shift to value-based reimbursement, combined with the consumer’s ability to evaluate performance, are in large part responsible for quality rising to stardom. What does this mean for the DNS, and how does the DNS navigate this new arena?
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  • March 3 CMS Quarterly Dementia Care Call to Target Infection Prevention, Staffing, Restful Environment: Register Now

    By CMS - January 05, 2020
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  • CASPER Reporting User’s Guide for MDS Providers UPDATED (1/20)

    By QTSO - January 04, 2020
    Provides information and instructions pertaining to CASPER Reporting, including accessing Final Validation Reports.
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  • CMS QSO Memo Sets Up Pending Emergency Preparedness Changes (12/19)

    By CMS - December 21, 2019

    The vast majority of this doesn’t apply directly to long-term care. Emergency preparedness is included, and obviously it does apply. However, most of the guidance for the LTC-specific emergency preparedness changes is still to come.

    Center for Clinical Standards and Quality/Quality, Safety & Oversight Group Ref: QSO-20-07-ALL

    DATE: December 20, 2019

    TO: State Survey Agency Directors FROM: Director Quality, Safety & Oversight Group

    SUBJECT: Burden Reduction and Discharge Planning Final Rules Guidance and Process

    Memorandum Summary

    • On September 30, 2019, the Centers for Medicare & Medicaid Services (CMS) published the Medicare and Medicaid Programs; Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction Final Rule, as well as the Revisions to Requirements for Discharge Planning for Hospitals, Critical Access Hospitals, and Home Health Agencies Final Rule.

    • This policy memorandum provides guidance to the CMS Regional Offices (ROs), the State Survey Agencies (SAs) and the Accrediting Organizations (AOs) regarding the changes to the regulations and our approach for updating the State Operations Manual (SOM) and applicable surveyor systems.

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  • Oct. 1, 2020 DRAFT MDS 3.0 v1.18.0 Posted, Change Document Still Pending (12/19)

    By CMS - December 20, 2019
    A new DRAFT version of the 2020 MDS item sets (v1.18.0) was posted. This version is scheduled to become effective October 1, 2020. Please note that Section G has been removed from all Federal item sets. The files are located in the Downloads section below. The MDS 3.0 Item Set Change History for October 2020 report will post to this webpage shortly.
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  • Top Ten Citations Part Three – Why Facilities Get Cited for F684 and F761

    By Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA - December 17, 2019

    A few months ago, we provided members with a list of the top ten federal deficiencies since January of 2019. Since then, articles have delved deeper into the top four citations. This month, we will examine the number five and six top citations, explore common reasons that facilities struggle to meet these regulations, and discuss why surveyors cite them.


    As a reminder, the top ten deficiencies are:

    1. F880 - Infection prevention and control

    2. F689 - Free of accidents, hazards/supervision/devices

    3. F812 - Food procurement/storage

    4. F656 - Develop/implement comprehensive care plan

    5. F684 - Quality of care

    6. F761 - Label/storage of drugs and biologicals

    7. F657 - Care plan timing and revision

    8. F758 - Free from unnecessary psychotropic med/prn use

    9. F677 - ADL care for dependent residents

    10. F550 - Resident rights

    (The citations above in red have the potential to cause substandard quality of care when a facility is cited at a scope and severity of F, H, I, J, K, or L level)

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  • Staff Education and Trauma-Informed Care: Training Basics

    By Caralyn Davis, Staff Writer - December 16, 2019

    The Centers for Medicare & Medicaid Services (CMS) most likely will specify education and training requirements for trauma-informed care under F741 (sufficient/competent staff‐behavioral health needs) and/or F949 (behavioral health training) in the upcoming revised Appendix PP, “Guidance to Surveyors for Long-term Care Facilities,” in the State Operations Manual—a revision that is now expected to be released in the second quarter of calendar year 2020, according to Quality, Safety, and Oversight (QSO) memo QSO-20-03-NH.


    When they arrive, those requirements may not be too onerous because many staff members already should have skills that will translate across to trauma-informed care, such as knowing how to de-escalate and how to work with residents who have memory impairments, says Jill Schumann, MBA, president and CEO of LeadingAge Maryland in Baltimore and co-author of the Foundations of Trauma-Informed Care Toolkit and Implementing Trauma-Informed Care: A Guidebook.


    Regardless of the exact requirements that CMS deems necessary, focusing on the following elements will help directors of nursing services (DNSs) and other members of the management team to implement effective trauma-informed care:

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  • Survey News: All Phase 3 Requirements of Participation Are Now in Effect

    By Caralyn Davis, Staff Writer - December 16, 2019

    The Phase 3 requirements of participation for long-term care facilities went into effect on November 28—even those requirements that the Centers for Medicare & Medicaid Services (CMS) proposed delaying in the July 18 Requirements for Long-Term Care Facilities: Regulatory Provisions to Promote Efficiency and Transparency Proposed Rule, according to CMS officials at the December 12 Skilled Nursing Facility Long-term Care Open Door Forum.

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  • Staffing Solutions Article Series: How to Improve Your Orientation Program and Encourage Staff Retention and Learning

    By Alexis Roam, MSN, RN-BC, DNS-CT, QCP - December 04, 2019

    Is the onboarding experience and orientation program in need of improvement in your nursing home? If so, you’re not alone; and the challenge is not unique to the healthcare industry. Only 12% of employees who completed the Gallup survey in 2017 said their employer did a good job onboarding them. According to surveys conducted by Digitate in 2018, only one in five employees would recommend their new employer to a friend after onboarding, and those who had a negative onboarding experience are twice as likely to look for new opportunities in the near future. With the demand high for a compassionate and competent workforce, and the current staffing crisis in post-acute care, investing in revitalizing the onboarding experience and orientation program in the nursing home could pay big dividends. The first article in the staffing solution series discussed ways to improve the onboarding experience using principles of hospitality. This article will build upon the first and discuss ways to improve the orientation program and encourage retention.

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  • Resident to Resident Altercations

    By Alexis Roam, MSN, RN-BC, DNS-CT, QCP - December 04, 2019

    Meet Ms. Smith and Mrs. Johnson

    During the DNS’s daily rounds, he overhears two CNAs conversing about how two residents frequently argue. The DNS inquires and learns Ms. Smith and Mrs. Johnson, both residents living in the memory care neighborhood, had an argument over a purse the previous evening. Ms. Smith grabbed the purse out of Mrs. Johnson’s hand, hit her twice with the purse, and walked away. Later the same day, a CNA sees Ms. Smith holding Mrs. Johnson’s arm and warning her to stay away from her purse or she will hit her with it again. Mrs. Johnson shakes her head and asks Ms. Smith to help her find her dog. The CNA re-directs Ms. Smith’s attention and assists her to her room so she can watch her favorite TV show. Two days later, Mrs. Johnson’s husband reports a bruise on his wife’s arm and is demanding to know what happened to her. There is no documentation in the medical record or incident report on file for any of the resident to resident altercations observed by the CNAs, nor the bruise. The following day, a state surveyor enters the facility to investigate a hotline complaint of abuse and requests the medical records for Ms. Smith and Mrs. Johnson.

    Ms. Smith and Mrs. Johnson probably remind readers of other residents currently or previously in their care. The scenario described is also likely familiar. However, the perception of and regulatory requirements related to resident to resident altercations have evolved, as has the expectation for each case to be investigated for potential abuse. F600 states “The resident has the right to be free from abuse, neglect, misappropriation of resident property, and exploitation as defined in this subpart.”

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  • Tuberculosis Screening, Testing, and Treatment of US Healthcare Personnel: Free CE (12/19)

    By CDC - December 04, 2019
    New FREE Continuing Education Activity from MMWR and Medscape

    CDC’s MMWR and Medscape are proud to introduce a new FREE continuing education (CE) activity. The goal of this activity is to describe updated National TB Controllers Association (NTCA) and Centers for Disease Control and Prevention (CDC) recommendations for screening, testing, and treating U.S. health care personnel (HCP) for tuberculosis (TB) to prevent transmission in healthcare settings.

    This activity is intended for public health/prevention officials, infectious disease physicians, hospital administrators, internists, pulmonologists, nurses and pharmacists and other physicians involved in prevention of TB transmission among and through HCPs.

    Upon completion of this activity, participants will:

    ·  Describe updated NTCA and CDC recommendations for baseline and postexposure TB screening and testing for HCPs

    ·  Determine updated NTCA and CDC recommendations for serial screening and testing for HCPs without latent TB infection

    ·  Identify updated NTCA and CDC recommendations for evaluation and treatment of HCPs with positive TB test results

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  • jRAVEN 1.7.2 Free MDS Submission Software Updated (12/19)

    By CMS - December 04, 2019

    jRAVEN (version 1.7.2) is now available for download which contains the following updates:  

    • A defect has been corrected that was causing the HIPPS score that is calculated in jRAVEN to not match the score calculated by the Submission System
    • Changes in support of the MDS Data Specifications Errata V3.00.3
    • The new MDS VUT, version 3.2.0, also updated in support of the Errata V3.00.3
    • All enhancements included with jRAVEN V1.7.0 & V1.7.1:
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  • Nursing Home Infection Control Self-Assesssment Worksheet From CMS and CDC (12/19)

    By CMS - December 02, 2019

    This 2019 Nursing Home Infection Control Worksheet (ICWS) is a collaborative effort by CMS and CDC and meant to be used by facilities as a self-assessment tool. It comprises both regulatory requirements and best practices in infection prevention and control. A facility that uses this ICWS will identify gaps in practice and have a “roadmap” that can lead to an improved infection prevention and control program. The assessment reviews the following domains:

    • Infection Control program infrastructure and Infection Preventionist
    • Infection Preventionist relationship to Quality Assurance Committee
    • Infection surveillance and outbreak response.
    • Influenza and pneumococcal Immunization
    • Linen management
    • Infection prevention during transitions of care
    • Water Management Program
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  • CMS Memo: Phase 3 Survey Guidance Will Be Released in Calendar 2Q 2020

    By CMS - November 27, 2019

    The Centers for Medicare & Medicaid Services (CMS) is announcing updates and initiatives aligning with the CMS strategic initiative to Ensure Safety and Quality in Nursing Homes. These updates and initiatives include:


    • Phase 3 Interpretive Guidance: CMS will be releasing updated Interpretive Guidance and training for the Requirements for Participation for Long-Term Care (LTC) Facilities. However, this guidance will not be released by the November 28, 2019 implementation date of the regulations. We will be releasing the guidance in the second quarter of calendar year 2020, along with information on training and implementing related changes to The Long Term Care Survey Process (LTCSP). While the regulations will be effective, our ability to survey for compliance with these requirements will be limited until the Interpretive Guidance is released.

    • Medicare and Medicaid Programs; Revision of Requirements for Long-Term Care Facilities: Arbitration Agreements: On July 18, 2019, the Department of Health and Human Services (HHS) published a final rule establishing requirements related to the use of binding arbitration agreements. This final rule amends the requirements that Long-Term Care (LTC) facilities must meet to participate with Medicare and Medicaid. 

    • Actions to Improve Infection Prevention and Control in LTC Facilities: CMS has created a nursing home antibiotic stewardship program training; updated the Nursing Home Infection Control Worksheet as a self-assessment tool for facilities; and is reminding facilities of available infection control resources.

    • Release of Toolkit 3, “Guide to Improving Nursing Home Employee Satisfaction”: CMS has created a toolkit that helps facilities improve employee satisfaction.

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