Long-term care leadership often observes that the nurse assessment coordinator (NAC) role calls for detail-orientation and strong time-management and assessment skills, because these nurses must coordinate the resident assessment that drives the care plan, quality …
Depression and other mood disorders historically have been a significant risk for nursing home residents. “In 2011 and 2012, the percentage of users of long-term care services with a diagnosis of depression was highest in …
The parameters of the COVID-19 public health emergency (PHE) are shifting at a rapid pace for nursing homes. In the midst of their work to implement (and document) a staff vaccination plan that includes a …
Nurse leaders who hear comments like “I didn’t know that happened,” “I didn’t realize that was important,” or “I didn’t know you wanted me to do that” from the charge nurses and certified nurse aides …
While still a small percentage of overall nursing home citations, citations at the level of immediate jeopardy (IJ) have skyrocketed since the start of the COVID-19 public health emergency, largely driven by an explosion of …
Without a full understanding of how the SLP component of the Patient-Driven Payment Model (PDPM) is calculated, it can seem complicated. The SLP methodology is detailed in the PDPM Calculation Worksheet for SNFs in chapter …
Since the implementation of the Patient-Driven Payment Model (PDPM) in the Medicare Part A Skilled Nursing Facility Prospective Payment System (SNF PPS), urinary tract infections (UTIs) can be coded on the MDS in up to …
AAPACN’s mission is to support the professional development, empowerment, and success of members with resources. We especially want to provide that support during the current COVID-19 emergency. Federal guidance is rapidly developing and changing. AAPACN …
Consider this common scenario: Mr. Smith, a resident with dementia, is scheduled to have a bath on Tuesday, but he’s combative. “Even veteran staff may be set on the idea that Mr. Smith has to …
Almost every facility has a daily “stand-up” meeting for its management team. When done well, this meeting can be a font of information for everyone involved. However, without structure and focus, it can become cumbersome. …
Imagine you are eating dinner in a restaurant. It is a small, quaint place with a warm, homey atmosphere. A man in the corner picks up his fork and begins to tap it loudly against …
The Interim Payment Assessment (IPA) in the Patient-Driven Payment Model (PDPM) of the Skilled Nursing Facility Prospective Payment System (SNF PPS) is completed solely at the discretion of the SNF—and so far, few providers have …
Although staffing has always been a challenge, the situation has worsened over the last year and doesn’t seem likely to improve anytime soon. An American Health Care Association (AHCA) survey found that 73% of 616 …
The September 2021 Full Text of Statements of Deficiencies is chock-full of survey citations involving a facility’s failure to investigate and respond appropriately to drug diversion. For example, some surveyor notes indicate that a facility …
During the pandemic, priorities shifted. They had to. The safety and care of the residents was the number one priority, and it required all hands on deck. Nurse assessment coordinators (NACs) found themselves working the …
The Brief Interview for Mental Status (BIMS) in MDS items C0200 – C0500 or, if appropriate instead, the Staff Assessment for Mental Status in items C0700 – C1000 is the basis of the cognitive level …
When a resident suffers a cardiac arrest in the facility, do nurses know how to initiate a code? If a resident elopes, do facility staff know what to do? When emergency events happen, such as …
While F-tags like F600 (Free From Abuse and Neglect) directly address acts of abuse, neglect, misappropriation of resident property, exploitation, and other critical—even criminal—incidents involving residents, the substandard quality-of-care tags F608 (Reporting of Reasonable Suspicion …
In nursing facilities, one of the primary regulatory requirements from Appendix PP of the State Operations Manual is that goods and services are provided to attain or maintain the highest practicable physical, mental, and psychosocial …
The Fiscal Year (FY) 2022 Skilled Nursing Facility Prospective Payment System (SNF PPS) final rule contains a number of finalized changes—from revised SNF PPS payment rates for FY 2022 to updates to the Skilled Nursing …
Imagine if the infection preventionist’s sole responsibility were to treat residents who have an infection. This suggestion seems odd because it ignores the scope and breadth of activities necessary to control and prevent infections for …
Staffing is difficult—that was a defining truth for nursing homes before the COVID-19 public health emergency created a full-blown staffing crisis that still is harming providers throughout healthcare. So, it may seem like the wrong …
At first glance, the methodology of the non-therapy ancillary (NTA) component of the Patient-Driven Payment Model (PDPM) seems simple: code qualifying items on the MDS to achieve points. Yet while the purpose of the NTA …
The Skilled Nursing Facility Healthcare-Associated Infections (SNF HAI) Requiring Hospitalization measure is one of two new quality measures (QMs) that the Centers for Medicare & Medicaid Services (CMS) adopted into the Skilled Nursing Facility Quality …
An effective in-service program not only ensures competency and meets regulatory requirements, but also incorporates many learning styles and fosters the enjoyment of learning. Given the resources that a facility must dedicate to its in-service …
Lead certified nursing assistant (CNA) programs can create positive change in nursing homes. While program goals often vary from facility to facility, lead CNA programs may improve resident quality of life and quality of care, …
“No one even looks at the care area assessments (CAAs) once they’re done, so why spend so much time on them?” It’s a conundrum that nurse assessment coordinators (NAC) and interdisciplinary team (IDT) members often …
Effective with the fiscal year (FY) 2023 Skilled Nursing Facility Quality Reporting Program (SNF QRP), SNFs must fulfill two separate but equal reporting requirements to avoid a 2 percent reduction in their annual payment update …
With the introduction of the vaccine mandate for nursing home employees, many organizational leaders fear staff, especially certified nursing assistants (CNAs), will quit rather than get the vaccine. This week, several industry experts have voiced …
Since the public health emergency began, both the Centers for Medicare & Medicaid Services (CMS) and directors of nursing services (DNSs) have been focused on infection control and prevention—and rightfully so. Yet while crisis-oriented actions …
Editor’s note: This is the final article in a three-part series on elopement prevention and response in nursing homes. The first article looked at risk assessment and care planning, and the second article addressed staff …
Yesterday, President Biden announced that nursing homes must vaccinate their staff or lose Medicare and Medicaid funding. The exact guidance and compliance requirements are expected in September. Although this mandate is an effort to help …
Rejection of care can occur in many ways—Mr. Jones refuses to have his nails trimmed; Mrs. Abrahams clenches her mouth, refusing to take medications in the evening; or Mr. Martin discharges against medical advice. However, …
MDS section B (Hearing, Speech, and Vision) is a lot more important than many nurse assessment coordinators (NACs) and other interdisciplinary team members give it credit for, says Jillian Martin, RN, BS, DNS-CT, RAC-MT, RAC-CTA, …
Appendix PP of the State Operations Manual details the requirements for F947 (Required in-service training for nurse aides). To comply with this regulation, a facility’s nurse aide in-service training program must: Ensure competence of all …
Editor’s note: This is the second article in a three-part series on elopement prevention and response in nursing homes. The first article addressed risk assessment and care planning, and a future article will tackle elopement …
F699 of the State Operations Manual (SOM) requires facilities to ensure that residents who have experienced trauma receive culturally competent, trauma-informed care (TIC) to eliminate or mitigate triggers that may cause re-traumatization of the resident. …
Swingtech, a contractor with the Centers for Medicare & Medicaid Services (CMS), alerts skilled nursing facilities (SNFs) that are not meeting the Skilled Nursing Facility Quality Reporting Program (SNF QRP) data submission threshold for the …
FY 2022 SNF PPS Final Rule: No PDPM Parity Cuts, but Other Changes Impact SNFs Providers can breathe a sigh of relief that the Centers for Medicare & Medicaid Services (CMS) will not move forward …
Conflict is a daily reality, yet many of us do our best to avoid it, dreading the time when we will have to navigate interpersonal disputes. Many nurse leaders are similarly uncomfortable with or do …
Editor’s note: This is the first article in a three-part series on elopement prevention and response in nursing homes. Future articles will address staff training, policy and procedure development, and elopement risk management, including mechanical …
During their first days on the job, new nurse assessment coordinators (NACs) can expect paperwork and orientation videos as they are introduced to their role. But what should a new NAC expect by the end …
It’s never a good time for a skilled nursing facility (SNF) to be hit with a two percent reduction in its Medicare Part A annual payment update (APU) due to not meeting the MDS data …
Nursing school does not prepare nurse leaders to interview job applicants, so figuring out the process to find the right candidate is often a challenge. Leaders want to find the best fit for the position—someone …
A physician who always sends residents to the emergency department (ED) when nurses call them about a significant change in condition, an advanced practice provider (APP) who routinely orders expensive and unnecessary tests, a physician …
With staffing shortages and specific, regulation-mandated job duties, nurse assessment coordinators (NACs) today may feel that taking time for vacation just isn’t possible. The NAC must ensure the facility has MDS assessments in place, makes …
Medicare managed care (Part C) plans, which are still predominantly Medicare Advantage plans, tend to conduct more medical reviews than traditional Medicare Part A contractors, says Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC, director …
The current weekly data provided by the Centers for Medicare & Medicaid Services (CMS) shows that 1,136 nursing homes have met the provider-set national goal of getting 75 percent of staff fully vaccinated with a …
One of a nursing student’s most exciting milestones is purchasing a stethoscope. In addition to serving as a critical tool, the stethoscope is also a symbol signifying that the nursing student has taken a leap …
Jessie McGill, RN, RAC-MT, RAC-MTA Every spring, the Centers for Medicare & Medicaid Services (CMS) releases the notice of proposed rulemaking (NPRM) for the next fiscal year’s (FY’s) payment policies and rates. This provides an …
The COVID-19 pandemic is quite diminished but still a concern in some nursing homes due in part to SARS-CoV-2 variants, as well as unvaccinated staff. With the public health emergency worsening the already significant staffing …
Urinary incontinence (UI), defined as any involuntary leakage of urine, affects over half the population living in post-acute long-term care (PALTC) and costs an estimated 5.5 billion annually, according to the Society for Post-Acute and …
“Against medical advice” (AMA) is a term that nursing homes use to describe a resident unexpectedly leaving the facility in a self- or representative-initiated discharge that is inconsistent with their identified care needs. “Some providers …
by Carol Maher, RN-BC, RAC-MTA, RAC-MT, CPC ICD-10-CM coding is not a skill nursing school conveys to students, yet it is one that nurse assessment coordinators (NACs) must acquire to perform their diagnosis coding duties …
The care area assessment (CAA) process sometimes mistakenly gets lumped under the “required but not critical to resident care” label of regulatory paperwork. While working the CAAs is indeed a mandatory step in the Resident …
Hand hygiene has always been a primary focus of infection prevention, but due to the COVID-19 pandemic, it is under intense scrutiny. Even though the skill of hand hygiene is straightforward and easy to learn, …
Falls are common in nursing homes—they are a driver of surveyor citations under F-tag 689 (Free of Accident Hazards/Supervision/Devices), which is consistently among the top three survey citations nationwide, according to the S&C QCOR online …
By Liz Barlow, RN, CRRN, RAC-CT, DNS-CT With the onset of the COVID-19 public health emergency (PHE), skilled nursing facilities (SNFs) have been focused on infection control, staffing, and heightened patient care. But as facilities …
As a group, the bowel MDS items H0400 (Bowel Continence), H0500 (Bowel Toileting Program), and H0600 (Bowel Patterns) impact nursing homes on multiple levels, including the following: The Nursing Home Quality Initiative Quality Measures (NHQI …
While many nursing homes thankfully are no longer in crisis staffing mode, recruiting staff remains a top priority in a highly competitive job market. “Staff recruitment breaks down into meeting two overarching challenges,” says Julie …
“Across the country, the high rate of turnover in long-term care is a serious workforce problem,” says Dr. Linda Shell, DNP, MA, BSN, DNS-CT, Chief Learning Officer, LindaShell.com. “The cost associated with this turnover—the organizational …
The past year has brought a multitude of changes for everyone, but especially those in nursing homes. While the public health emergency (PHE) situation continues to evolve, the Centers for Medicare & Medicaid Services (CMS) …
We have all struggled with a stubborn knot or tangle at some point in our lives—whether it’s your kids’ shoelaces, your earbud cord, a garden hose, or even a fishing line. If you are a …
Traditional fee-for-service Medicare Part A is a national program with a core set of program guidance from the Centers for Medicare & Medicaid Services (CMS) in the Internet-Only Manuals and the Long-Term Care Facility Resident …
The 2021 AAPACN Conference featured a highly-anticipated session, “ReFOCUS: 2021 CMS Regulatory Updates,” in which representatives from the Centers for Medicare & Medicaid Services (CMS) shared their insights on current regulatory challenges and future regulatory …
Mental and behavioral healthcare is one of many resident care needs that transitioned to telehealth (i.e., telephone or video visits) in nursing homes during the COVID-19 pandemic. The U.S. Department of Health and Human Services, …
By Liz Barlow, RN, CRRN, RAC-CT, DNS-CT – April 20, 2021 The federal government focuses intently on preventing fraud, waste, and abuse within the Medicare system. As a part of those efforts, the Program for Evaluating Payment …
MDS item O0100 (Special Treatments, Procedures, and Programs) has 12 sections with two columns (24 total subitems) that identify specific services the resident received either while not a resident (column 1) or while a resident (column …
The safety of residents is a top priority for a skilled nursing facility (SNF). But how does one promote safety in such a dynamic environment? Three critical steps the director of nursing services (DNS) and …
While areas of concern related to medication administration (i.e., medication pass or med pass) are specific to each facility, there are certain common issues. Directors of nursing services (DNSs) can use the following tips to …
On April 8, the Centers for Medicare & Medicaid Services (CMS) released for public inspection the Fiscal Year (FY) 2022 Proposed Rule for the Skilled Nursing Facility Prospective Payment System (SNF PPS) and Consolidated Billing, …
Although the Centers for Medicare & Medicaid Services’ (CMS) beneficiary notices have been part of Medicare regulations for a long time, they can still be cited during any survey. Lengthy discussions in the AANAConnect LTC …
Observation and assessment of a resident’s condition is a skilled service under Medicare Part A that many nurse assessment coordinators (NACs) and Medicare case managers hesitate to use because it’s not a direct skilled nursing …
It’s hard to believe that it has been a year since the first nursing home resident contracted the novel coronavirus. Our way of living changed drastically, especially in long-term care. In-person visitation ended, and residents …
While data on hospital readmissions of skilled nursing facility (SNF) residents who have had COVID-19 following SNF discharge currently remains scarce, at least one study indicates the need for careful management of the discharge planning …
The Patient-Driven Payment Model (PDPM) uses 161 MDS items to establish the five case-mix adjusted components. Some of these 161 items will have supporting documentation easily found in the medical record, but other items may …
MDS item M1200 (Skin and Ulcer/Injury Treatments) in section M (Skin Conditions) can impact payment under the Patient-Driven Payment Model (PDPM) in the Medicare Part A skilled nursing facility prospective payment system (SNF PPS), as …
“Heroes work here.” It was a common theme in the early days of the pandemic. Signs were placed in front of the facility, and people would cheer and line the streets as healthcare personnel went …
Long-term care is in a difficult state right now, acknowledges Jessie McGill, RN, RAC-MT, RAC-MTA, curriculum development specialist at AAPACN. “It has been a full year of battling COVID-19. The pandemic heavily impacted residents, staff, and …
Chronic conditions and comorbidities are common among both long-term residents and short-term patients in skilled nursing facilities (SNFs). However, when the symptoms from these chronic conditions become part of the resident’s normal routine, they may …
MDS items N2001 (Drug Regimen Review), N2003 (Medication Follow-up), and N2005 (Medication Intervention) are the primary drivers of the Skilled Nursing Facility Quality Reporting Program (SNF QRP) Quality Measure (QM), Drug Regimen Review Conducted With …
One year. When asked how long it takes a new nurse assessment coordinator (NAC) to fully learn the job, I say at least one year. The nuances of the Resident Assessment Instrument (RAI) and Minimum …
The Confusion Assessment Method (CAM) is a standardized cognitive assessment that determines whether a resident has signs and symptoms of delirium. The CAM is located in MDS item C1310 (Signs and Symptoms of Delirium), which …
There is a phenomenon of hostility among nurses and certified nursing assistants (CNAs), commonly referred to as “nurses eating their young.” This incivility is pervasive, often seen as a rite of passage, and directed at …
As the COVID-19 pandemic eases, directors of nursing services (DNSs) may want to turn their attention to the care area assessments (CAAs) in the Resident Assessment Instrument (RAI) process, suggests Barbara Bates, RN, MSN, RAC-CT, …
Accepting a new position as the director of nursing services (DNS) often begins with excitement for the new challenges and many opportunities to make a positive difference. However, in the first few days and weeks, …
Effective Communication: Get the Nursing Team on the Right Track Establishing strong, open communication in the nursing department has always been a challenge, says Suzy Harvey, RN-BC, RAC-CT, director of clinical specialty services for Foster …
The nurse staffing shortage that simmered in long-term care—and throughout the entire healthcare field—for years finally boiled over in 2020 as a result of the COVID-19 pandemic, with nursing homes nationwide reporting sometimes crisis-level staffing …
MDS section G (Functional Status) is not used in the Patient-Driven Payment Model (PDPM) under the Medicare Part A Skilled Nursing Facility Prospective Payment System (SNF PPS), nor is it used in the Skilled Nursing …
Federal regulations require nursing homes to provide safe, individualized medication administration to residents. However, even before the COVID-19 public health emergency, many consultant pharmacists only went to nursing homes once a month for medication regimen …
By Jessica Kunkler, MA When interviewing for a new position, don’t forget that an interview is a two-sided exchange. “Not only is the facility interviewing you to determine if you’re a good fit for them, but …
Early 2021 could be challenging for the nation’s nursing homes. Recent trends in infection rates combined with the slow rollout of the COVID-19 vaccine have the potential to make the coming months “the deadliest of …
On Dec. 2, 2020, the Centers for Medicare and Medicaid Services (CMS) released the Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS) Final Rule. However, on Dec. 21, 2020, Congress passed the Consolidated Appropriations …
By Shahin Sanjar, PhD., Sunovion Pharmaceuticals Inc. Inhalation treatment of respiratory conditions such as asthma and COPD is the predominant mode of therapy for the simple and logical reason that applying pharmacological agents to the target …
Nursing home staff members, like everyone in the United States and across the globe, want to go back to “normal.” However, directors of nursing services (DNSs) need to ensure that infection prevention and control remains …
Amid nationwide staffing shortages, veteran nurse assessment coordinators (NACs) often are being pulled to work the floor, and new NACs are coming on board with limited MDS training, notes Maureen McCarthy, RN, BS, RAC-MT, QCP-MT, …
The phone rings early one Saturday morning; it’s the night shift nurse calling to tell you that Mrs. Jones has a large bruise on her chest and staff does not know how it occurred. What …
As of 2017, 66 percent of nursing homes used an electronic health record (EHR) in some capacity, according to the Office of the National Coordinator for Health Information Technology. However, directors of nursing services (DNSs) …
MDS accuracy is no joking matter, but who can resist a good dietary-related pun? I decided I would take a whisk and go for it. While nutrition has always played a key roll in the …
Skilled nursing facilities now have more than a year of experience with the Patient-Driven Payment Model (PDPM), the updated case-mix classification system used in the Medicare Part A Skilled Nursing Facility Prospective Payment System (SNF …
