Fiscal Management and Budget Efficiency During Lean Times

When a skilled nursing facility (SNF) is operating on a tight budget, while also being census- and staff-challenged, the director of nursing services (DNS) needs to be more directly and proactively involved in fiscal management of the nursing department. “It can be very scary, especially for a new DNS,” says …

Achieving Strong Resident Quality of Life Starts With Better Staff Management

Quality of life is a “fundamental principle” that feeds into—and flows from—all resident care and services, according to 42 Code of Federal Regulations (CFR) §483.24. The F-tag 675 surveyor guidance in Appendix PP of the State Operations Manual offers insights on the definition of quality of life and what it …

Person-Centered Fall Prevention Interventions: Beyond Rehab Screen and 15-Minute Checks

The Centers for Disease Control and Prevention (CDC) cites falls as the leading cause of injury-related death in adults aged 65 and older (CDC, 2023). It is imperative that nursing facility staff identify fall risk in their residents and care plan accordingly. A fall risk assessment can help to identify …

Culturally Competent Care Planning: What It Takes to Get It Right

Effective with the Oct. 1, 2023, implementation of MDS v1.18.11, items A1005 (Ethnicity), A1010 (Race), A1110 (Language), and B1300 (Health Literacy) will provide nurse assessment coordinators (NACs) and other interdisciplinary team members with a starting point for creating more culturally competent care plans—especially if the team conducts a more detailed …

Turnover Solutions Series – Part 1: Interpreting the Staff Turnover Rate

During a QAA/QAPI meeting, the director of human resources announces the monthly staff turnover rate and shares information about a job fair she will attend. After this report, another department director takes a turn sharing data, and the meeting carries on in this manner until all departments have spoken. There …

Pain Management for Residents With OUD: Prioritize Staff Training

Like every aspect of nursing home operations, staff education and training are critical to providing pain management for residents with opioid use disorder (OUD), other substance use disorders, or an addiction history. Each resident’s pain management plan should be highly resident-centered and individualized, says Annette Sanders, MSN, RN, CLNC, ICP, …

5 Major MDS Changes and How to Operationalize What’s Coming October 1, 2023

Significant changes are coming with the Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual, version 1.18.11, which will become effective October 1, 2023. Facilities that prepare ahead of time will integrate the updates into their processes more smoothly and move ahead with confidence that their team can ensure MDS …

Set up an Audit Response Process to Navigate TPE

Skilled nursing facilities (SNFs) seem to be experiencing a significant uptick in Targeted Probe and Educate (TPE) prepayment medical review of fee-for-service Medicare Part A claims, says Stacy Grondel, RN, BN, RAC-CTA, RAC-MT, QCP, CMAC, director of medical review and education for Salt Lake City, UT-based Avalon Health Care Group. “Over …

Ethnicity, Race, Language, Health Literacy: New MDS Items Are a Cultural Starting Point

Effective Oct. 1, 2023, seven social determinants of health (SDOH) standardized patient assessment data elements (SPADEs) will be added to the MDS v1.18.11 item sets as follows: SDOH Items on the MDS v1.18.11 Draft Item Sets Item ND  NPE NC NQ NT NP IPA A1005 (Ethnicity) X X X X …

How NACs Can Support Administrative Level of Care Presumption During Medical Review

When a Medicare beneficiary is admitted to a skilled nursing facility (SNF), there are specific requirements that the resident must meet for the facility to bill Medicare for the services provided. The physician must certify that the skilled care in the SNF is necessary; the resident must have Medicare benefit …