F677: How to De-Risk ADL Care for Dependent Residents

Providing residents with the appropriate level of assistance in the activities of daily living (ADLs) is foundational to care in nursing homes, yet the ADLs consistently remain a common citation risk in the survey process. From 2021 to summer 2024, F677 (ADL Care Provided for Dependent Residents) is the eighth most-cited F-tag …

Skilled Teaching and Training: Benefit From the Care Team’s Expertise

Like care plan management and evaluation and observation and assessment of a resident’s condition, teaching and training activities are a core nonskilled component of resident care that can rise to the level of a skilled service. Another way that these indirect skilled services are alike is that they historically haven’t …

Quality Measure IQ Series: Discharge Function Score Measure

The newest section GG Quality Measure (QM), the Discharge Function Score, has left many nurse assessment coordinators (NACs) with more questions than answers about how it is calculated. This measure estimates the percentage of Medicare Part A skilled nursing facility (SNF) stays that meet or exceed an expected Discharge Function …

Navigating the Role: Essential Training for New Nurse Assessment Coordinators

Navigating the multifaceted role of the nurse assessment coordinator (NAC) can be daunting, especially for those new to the position. Whether titled NAC, MDS coordinator, Medicare case manager, or another variant, the responsibilities are both far reaching and crucial to ensuring quality care in long-term care facilities. As facilities increasingly …

Staff Work Schedules: It’s Time to Get Flexible—and Realistic—to Improve Retention

Flexible scheduling, which allows staff members to opt for shorter shifts, longer shifts, add-on shifts, and other staffing flexibilities, can be a strong tool for both recruitment and retention in long-term care, says Jasmine Travers, PhD, MHS, RN, AGPCNP-BC, assistant professor at the New York University Rory Meyers College of …

Staff Performance: When Expectations Don’t Match Reality

To implement the minimum nurse staffing standards for registered nurses (RNs) and nurse aides (NAs) and the increased on-site RN requirement in the Minimum Staffing Standards for Long-Term Care (LTC) Facilities and Medicaid Institutional Payment Transparency Reporting final rule starting as early as May 2026 on some requirements for urban …

Substance Use Disorders: What the DNS Should Know

Over 1 million people aged 65 and over live with substance use disorders (SUD) (Alliance for Aging Research, 2022). As with most trends, what is prevalent in the community will also be prevalent in nursing homes. Therefore, the director of nursing services (DNS) should understand the nuances of this disorder …

Preferences and Routines: Use Section F to Collaborate on the Care Plan

The Resident Assessment Instrument (RAI) process begins with the Minimum Data Set (MDS) assessment and ends with the resident-centered comprehensive care plan. In the MDS, section F focuses on the resident’s preferences for customary routines and activities, asking scripted questions about how the person rates the importance of these items. …

Skilled Observation and Assessment Hinges on a Reasonable Probability of Complication

Direct skilled services under Medicare Part A often are easy to identify because these services involve specific, complex caregiver-to-resident actions. Their “inherent complexity” means that they can “be performed safely and/or effectively only by or under the general supervision of skilled nursing or skilled rehabilitation personnel,” explains the Centers for …

Care Plan Management and Evaluation Can Be a Skilled Service for At-Risk Residents

The development, management, and evaluation of the resident care plan is the OBRA backbone of the Resident Assessment Instrument (RAI) process for all residents regardless of payer source, so it may surprise some nurse assessment coordinators (NACs) and directors of nursing (DNSs) to learn that care plan management and evaluation …