Educational Planning Starts—but Doesn’t Stop—With the Facility Assessment

Using the facility assessment to create an educational planning table seems pretty simple, but effective educational planning requires a more comprehensive, ongoing approach that addresses both competencies and global training needs identified from multiple sources. Keys to creating a solid educational planning process that begins but doesn’t end with the …

Baseline Care Plan: Connecting the Dots to the Comprehensive

Unlike the baseline care plan, the comprehensive care plan is largely MDS-based and analysis-driven, points out Mary Madison, RN, RAC-CT, CDP, a long-term care and senior living clinical consultant for Briggs Healthcare in Clive, IA. “It goes beyond the minimal requirements for the baseline. As a result of these differences, some …

Communicating Comfort: Help the IDT Help the Residents and Themselves

The clinical skills that nursing home staff need to care for residents are just one piece of the care puzzle, says Joan Devine, RN, LNHA, the Weldon Springs, MO-based director of education for the Pioneer Network. “You don’t want staff to go in with a singular focus on tasks when …

Part A Physician Certs/Recerts: Don’t Strike Out on This Condition of Payment

Physician certifications and recertifications are a technical requirement of payment (i.e., a condition of payment) under fee-for-service Medicare Part A. These certifications are needed to verify that a resident requires daily skilled care in a skilled nursing facility (SNF) for an ongoing condition for which they received inpatient hospital services …

Coding Diagnoses in MDS Section I: The Art of the Physician Query

The coding instructions for MDS section I (Active Diagnoses) in the Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual require that every diagnosis coded in this section be documented by a physician or a physician extender (i.e., a nurse practitioner, physician assistant, or clinical nurse specialist when allowed under …

Preventing Unnecessary ED Visits: Steps That Can Reassure Residents and Families

Residents or their family members sometimes demand to be sent to the emergency department (ED) for an issue that the nursing home can handle in-house. Unnecessary ED trips can disrupt the continuity of care, be traumatic for the residents, and potentially lead to hospital inpatient admissions that could have been …

Coding Malnutrition and Morbid Obesity on the MDS: Two Core Rules Must Be Followed

The most common mistake that nurse assessment coordinators (NACs) and other MDS assessors make when coding malnutrition, at risk for malnutrition, or morbid obesity on the MDS is being unaware that a dietitian cannot diagnose these conditions, says Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC, director of education for …

Family Reluctance for Hospice: Keys to Overcoming Stigmas

“When does Mom get the black pill?” Families sometimes ask hospice providers this type of question—mistakenly thinking that hospice is a form of assisted suicide—even though hospice services were introduced in the United States more than 40 years ago, says Rick Russell, MBA, BSN, RN, CHPCA, president/CEO of Hospice of Northwest …

Changing ARDs and Assessment Windows: When to Consider This Step

Nurse assessment coordinators (NACs) often set assessment reference dates (ARDs), which determine the look-back periods for MDS assessments, using a fairly regimented schedule to establish consistency in the Resident Assessment Instrument (RAI) process. However, an assessment scheduling process that is too rigid can result in missed opportunities on several levels, …

The SNF/HHA Handoff: Keys to a Strong Transition of Care

In the survey process, two F-tags primarily govern interactions between skilled nursing facilities (SNFs) and home health agencies (HHAs): F660 (Discharge Planning Process) addresses the requirement for nursing homes to assist residents and their families in selecting an HHA when needed, and F661 (Discharge Summary) lays out the requirement that …