AAPACN is dedicated to supporting post-acute care nurses provide quality care.

Tools

Post-Acute Care Tools from AAPACN

Check out this continually growing list of free downloadable tools created by AAPACN nurse experts. These tools will help you and your team get on the same page with changing regulations, interrupted stay issues, and survey readiness. Want access to all AAPACN articles? Learn more about AAPACN and AAPACN membership.


  • Discharge Process Checklist
    Discharge planning is the process of transitioning a resident from the facility to a lower level of care. The goal of each discharge is to establish a person-centered discharge plan that prevents avoidable readmissions to …
  • Five-Star Staffing Measures Scoring and Methodology Tool
    The July 2022 Care Compare refresh reflected a major overhaul of how the Five-Star Staffing stars are calculated. The staffing domain is now based on six staffing measures, three based on hours per resident day …
  • Interrupted Stay Tracker Tool
    For Medicare residents, nurse assessment coordinators (NACs) need to determine whether an interrupted stay has occurred and ensure that the correct MDS assessments, both OBRA and PPS, are in place. AAPACN’s Interrupted Stay Tracker tool …
  • Interrupted Stay Policy Quick Guide
    The interrupted stay policy designates that a Medicare stay is considered a continuous stay when it is interrupted by less than three non-covered days. AAPACN’s Interrupted Stay Policy Quick Guide provides the key facts for …
  • Interrupted Stay Flow Chart
    Determining whether an interrupted stay has occurred can be a challenge, especially when so many different factors must be considered. AAPACN’s enhanced  Interrupted Stay Flow Chart will help nurse assessment coordinators (NACs) navigate different scenarios to …
  • Medicare A2400C Algorithm with the NPE and Interrupted Stay
    AAPACN has adapted the A2400C flow chart from section A of the RAI User’s Manual to show how A2400C impacts how the nurse assessment coordinator (NAC) schedules the PPS Part A Discharge assessment and how …
  • Quality Assurance and Performance Improvement (QAPI) Meeting Tools
    QAPI is a data-driven, proactive approach to improving the quality of care, life, and services for residents. A QAPI meeting is an opportunity for the QAA/QAPI Steering Committee to discuss performance of the full scope …
  • Quick Facts – SNF QRP Proposed Measure: Influenza Vaccination Coverage among Healthcare Personnel
    The Centers for Medicare & Medicaid Services (CMS) proposed a new Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) measure that will potentially be included in FY 2025 program year. The Influenza Vaccination Coverage Among …
  • Learning Timeline for AAPACN Education and Resources
    Are you considering advancing your career and looking to gain knowledge to be successful in your next role? Or are you already in the position you love but looking to improve your knowledge for additional …
  • Mandatory Training Checklist
    Government entities require mandatory staff trainings to be completed at least annually. AAPACN’s Mandatory Training Checklist is intended to assist the facility leader in ensuring staff have completed mandated trainings per facility policy. For permission …
  • Resident Cognitive Level Determination: For the SLP and Nursing Components Under PDPM
    If the BIMS interview is not completed, the PDPM Cognitive Level will be used to determine cognitive impairment under the SLP and Nursing components of PDPM. AAPACN has updated its Resident Cognitive Level Determination Tool to help nurse …
  • Skilled Nursing Facility COVID-19 Related Waivers At-a-Glance
    The Centers for Medicare & Medicaid Services (CMS) have issued several blanket waivers and updates, as well as terminated selected waivers. AAPACN has developed the SNF COVID-The Centers for Medicare & Medicaid Services (CMS) have …
  • Stay Interview Template and Action Plan
    A stay interview is a conversation between the manager and employee to learn why the employee continues to choose the company as their place of employment—what keeps them coming back every day. Moreover, it’s an …
  • Social Determinants of Health and the Impact on Discharge Planning
    Using social determinants of health (SDOH) when developing a resident’s discharge plan can help identify and address potential risks that could adversely affect the resident’s ability to safely discharge back to the community. AAPACN’s Social …
  • Updated AAPACN In-Service Education Tools
    AAPACN’s expert-developed in-service education tools are user-friendly training documents to supplement your staff’s knowledge and get your team on the same page. Several of our in-service education tools have recently been updated with new approaches to …
  • Hospice Collaboration Toolkit
    The Hospice Collaboration Toolkit assists facility leaders to understand hospice services and provides guidance on how to enhance collaboration, thus improving the quality of care and the quality of life for residents nearing end-of-life experience. …
  • Crisis Mode: RAI Process Survival Checklist tool
    Severe staffing shortages have led to nurse assessment coordinators (NACs) working the floor and not having the time to dedicate to the MDS and RAI process. When the facility is in a staffing crisis mode, …
  • At-a-Glance QM, QRP, and VBP Tool
    With so many Quality Measures originating from three different payment initiative programs, it’s a lot to keep track of. AAPACN’s At-a-Glance QM, QRP, and VBP tool organizes all of the measures for you. This tool has been …
  • Section GG Process Flow Chart Tool
    The functional assessment coded in section GG often brings with it many questions— Should therapy complete this section? What type of documentation is needed? Can I use nurse aide documentation? How do we determine usual …
  • Stretch and SMART Goal Setting Worksheet Tool
    Goal setting for personal, professional, and organizational growth is a proven tactic to help individuals and teams achieve higher performance. Nurse leaders can use this worksheet to help their team or themselves develop a stretch …
  • PDPM At-a-Glance Tool
    The PDPM At-a-Glance tool breaks down the complex methodology of each component used in the Patient-Drive Payment Model—physical therapy (PT), occupational therapy (OT), speech-language pathology (SLP), non-therapy ancillaries (NTA), and nursing. This tool provides key …
  • Admission Sample Questionnaire Tool
    This conversation starter will help your team learn more about a new residents’ interests, routines, and goals and engage the resident in their care planning right from admission. AAPACN’s Admission Sample Questionnaire tool (print) can …
  • OBRA Scheduling Tools for Calendar Year 2022
    AAPACN offers two great tools to assist nurse assessment coordinators (NACs) schedule OBRA assessments. Be prepared for 2022 with these two tools that are free to members: The Static OBRA Scheduling Tool is a 4-page tool that …
  • Morning Stand-Up Meeting Minutes Tool
    Morning stand-up is meant to be a brief meeting (15 minutes or less) to exchange information that affects the operations of multiple departments on that given day. The information exchanged should be shared with the …
  • Emergency Drills: Code and Elopement Toolkit
    When emergency events happen, such as cardiac and respiratory arrest or an elopement, it is imperative that staff know how to respond. Nurse leadership should provide opportunities for staff to practice and perfect their response …
  • NAC Preparation Guide for the Triple Check Meeting Tool
    Gathering all of the necessary reports for the triple check meeting is a lot for nurse assessment coordinators (NACs) to keep track of. Use the AAPACN’s NAC Preparation Guide for the Triple Check Meeting to …
  • SNF QRP Quick Facts Tools
    Two new Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) measures become effective Oct. 1, 2021—the COVID-19 Vaccination Coverage Among Healthcare Personnel (HCP) and the Healthcare-Associated Infections (HAI) Requiring Hospitalization. AAPACN has put together the …
  • State PDPM Data Collection Map Tool
    AAPACN has surveyed state RAI Coordinators, automation coordinators, and other stakeholders in all fifty states to develop a map which provides important guidance on the status of states collecting Patient-Driven Payment Model (PDPM) billing codes …
  • MDS Quality Measures: Data Timeframes and Correction Periods Tool
    A common question regarding Quality Measures is how quickly does an MDS need to be corrected to still impact MDS 3.0 Quality Measures. AAPACN’s MDS Quality Measures: Data Timeframes and Correction Periods tool will help …
  • Nurse Aide (CNA) In-Service Training and Competency Tracker Tool
    F947, Required in-service training for nurse aides, requires that each certified nursing assistant (CNA) complete a minimum of 12 hours of in-service training per year starting on the CNA’s hire date. Nurse leaders can customize …
  • Interview Template Tool
    Nurse leaders want to hire candidates with the right characteristics and talents necessary to be successful in their jobs. AAPACN’s new Interview Template Tool allows the nurse leader to customize the desired characteristics and talents, …
  • MDS Daily Startup for the NAC Backup Tool
    When the nurse assessment coordinator (NAC) goes on vacation, there’s a lot to keep track of while they are out of office. The MDS Daily Startup for the NAC Backup tool is intended to help …
  • COVID-19 Diagnosis Coding Guidance Timeline for Auditing Claims Diagnosis Coding Tool
    Recently, CMS resumed medical reviews for Medicare claims for dates of service after March 2020; however, it may be difficult for facility staff to audit COVID-19-related diagnoses due to how frequently guidance was updated from …
  • Skilled or Not? Tool – REVISED
    Understanding the technical and skilled level care requirements for Medicare A is always a challenge. We’ve broken down the process with our Skilled or Not? tool . This tool was originally published in April 2017. It has …
  • Maximizing Your Pharmacy’s Benefits Tool
    AAPACN’s latest set of tools provides nurse leaders with guidance on how to best utilize the pharmacy’s services and expertise and assists nurse leaders to collaborate with the pharmacist and maximize his or her expertise …
  • Interim Payment Assessment Considerations Tool
    A question that comes up often lately for nurse assessment coordinators (NACs) is, “Should I do an IPA?” The assessment is optional, which can also make deciding when to complete one a challenge. Depending on …
  • Guide to Resident-at-Risk
    by AAPACN To meet the needs of medically complex residents, a holistic, individualized approach to care is required, including when a resident is at risk for a decline or change in condition. This guide provides …
  • MDS Data Collection for the NAC Tool
    Do you have an organized approach to collect MDS data during the 7- and 14-day look-back periods? AAPACN’s MDS Data Collection for the NAC tool provides an organized approach to gathering supporting data from the …
  • AAPACN Onboarding Essentials: Welcoming Staff to Promote Retention Tool
    Retaining a talented workforce is a top priority; to achieve this goal, leaders must create a welcoming onboarding experience. This toolkit presents education for department managers and administration as well as tools leaders can use …
  • 10-Week Nurse Assessment Coordinator Orientation Guide Tool
    Orientation for a new nurse assessment coordinator (NAC) is a very complex and long process. It is important to establish a realistic schedule that will allow for effective learning but will not be overwhelming. AAPACN’s …
  • Certified Nurse Aide (CNA) Retention Tip Sheet Tool
    Leadership significantly affects CNA retention. To improve your facility’s CNA retention, as a leader, use the Certified Nurse Aide (CNA) Retention Tip Sheet that outlines the five leadership principles and 10 actions to help leaders …
  • MDS Items Impacting Reimbursement for RUG-IV, PDPM, and SNF QRP – Updated Tool
    Do you know what MDS items impact reimbursement under the previously used RUG-IV system and now used under PDPM? Do you know which items are used to calculate the SNF QRP threshold? Use this quick …
  • Beneficiary Notice Guidelines Tool
    Are you confused about which beneficiary notices are needed and when? The updated Beneficiary Notice Guidelines tool lists scenarios that you might run into, clarifying exactly what notices are needed to reduce the risk of claim denials …
  • Survey Readiness: Critical Element Pathways, Observations, Reviews, and Policy Calendar Tool
    Surveyors use critical element pathways (CEPs) to work through the steps of their investigation and to determine compliance with several federal regulations. In addition to CEPs, other tools including observational guides are also used to …
  • SNF Audits and Appeals by Payment Type Tool
    In the skilled nursing facility (SNF), the nurse assessment coordinator (NAC) may need to be familiar with many different payer types, as well as different audit and appeal processes. The AAPACN SNF Audits and Appeals …
  • Employee File Audit Sheet
    All long-term care facilities must compile and maintain a personnel file and a medical file for each employee. AAPACN’s Employee File Audit Sheet is intended to assist facility leaders in their review of the employee …
  • COVID-19 Tools from AAPACN
    In response to the COVID-19 pandemic, AAPACN is developing several tools and resources to help LTPAC providers. The tools and resources available to date include: Updated Personal Protective Equipment (PPE) Donning and Doffing Competency Tool COVID-19: …
  • COVID-19 Tools From AAPACN
    In response to the COVID-19 pandemic, AAPACN is developing several tools and resources to help LTPAC providers. The tools and resources available to date include: Updated Personal Protective Equipment (PPE) Donning and Doffing Competency Tool COVID-19: …
  • Influenza and Pneumonia Vaccination Toolkit
    The flu season is here, and yearly vaccination is a key component of an infection control program. The Influenza and Pneumonia Vaccination Toolkit will assist the director of nursing services (DNS) with auditing influenza and …
  • Section GG Data Collection Tool for OBRA Assessments
    Is your state collecting PDPM data on OBRA assessments? Use AANAC’s Section GG: Three-Day Performance Data-Collection Tool for OBRA Assessments to help guide your staff in documenting the resident’s performance during the window for each …
  • Guide to Key MDS-Related CASPER Reports for the Nurse Assessment Coordinator (NAC) Tool
    A systematic approach to utilizing the CASPER reports is necessary for monitoring Quality Measures, managing MDS assessments, and reimbursement. While there are numerous reports available via CASPER, AANAC’s new Guide to Key MDS-Related CASPER Reports …
  • Guide to Primary CASPER Reports for the Director of Nursing Services Tool
    Feel overwhelmed by all of the reports available on CASPER? AAPACN’s Guide to Primary CASPER Reports for the Director of Nursing Services tool highlights the primary reports of interest to the director of nursing services (DNS) …
  • The Use of the Disaster Related “DR” Condition Code for SNF Claims Tool
    CMS has implemented two emergency waivers of the QHS and Benefit Period requirements under §1812(f) of the Social Securty Act to help restore SNF coverage that beneficiaries affected by the emergency would be entitled to …
  • Weekly Medication Storage Inspection Tool
    Correct medication storage is a component of the nurse leader’s responsibility and should be part of their rounds. The AAPACN Weekly Medication Storage Inspection tool assists the reviewer to conduct inspections for compliance, and also …
  • Comprehensive Diagnosis Collection Flow Chart Tool
    ICD-10-CM coding plays a substantial role in the accuracy of Medicare reimbursement under PDPM. However, collecting this information often requires a lot of research and queries or clarifications with the resident’s physician. AANAC’s new Comprehensive …
  • Daily Clinical Rounds Tool
    Daily clinical rounds allow the nurse leader opportunities to connect with staff and residents, gain valuable information, reinforce consistency of standards, and model clinical leadership behaviors. The AAPACN Daily Clinical Rounds tool assists the nurse …
  • Physician Certification Tracker Tool
    AANAC’s new interactive Physician Certification Tracker adjusts the certification signature due dates when the data entered indicates that a resident had an interrupted stay. This tool will help ensure your team remains in compliance with …
  • Guide to a Successful Meeting Tool
    Meetings are a normal and necessary part of daily operations, but it is important to spend the time wisely so that the meeting achieves its intended purpose. AADNS’s Guide to a Successful Meeting tool will …
  • Investigation Checklist Tool
    Investigations are a necessary component of a facility’s operations. They aid the nurse leader by establishing the facts of the situation, identifying opportunities to improve care and services, and mitigating further safety, legal, and compliance …
  • Medicare Advantage Plan (Part C) Denials and Appeals Quick Guide Tool
    Do you know the next steps to take if your resident or their representative appeals a Medicare Advantage Plan coverage decision? AANAC’s new Medicare Advantage Plan (Part C) Denials and Appeals Quick Guide will help …
  • Quick Guide to LTC Critical Element (CE) Pathways for the NAC Tool
    Surveyors are required to use the critical element pathways in assessing compliance with federal requirements. Do you know what pathways the NAC needs to know? Find them all in one place in AAPACN’s latest Quick …
  • 10 Fast Facts about Trauma-Informed Care Tool
    F699 Trauma Informed Care requires facilities ensure residents who are trauma survivors receive culturally competent care that eliminates or mitigates triggers that may cause re-traumatization. Access the Fast Facts About Trauma Informed Care to learn …
  • Trauma-Informed Care Fast Facts Tool
    Do you know what trauma-informed care is and who is at risk? In AANAC’s Trauma-Informed Care Fast Facts tool, you’ll get the quick and important details you need to know about trauma-informed care in relation …
  • Policy and Procedure Review and Development Guide Tool
    Policies and procedures are essential to the operation of your organization because they provide written structure and clarity for employees and inform all staff of the expectations for how to go about the work they …
  • CGS Additional Development Request Timeliness Calculators Tool
    In May 2019, CGS Administrators, LLC. posted two Additional Development Request Timeliness Calculators (Part A and Part B). Use these tools to help you determine the date ADR documentation should be received by the Medicare …
  • IPA Algorithm Tool
    Do you and the interdisciplinary team know when an Interim Payment Assessment (IPA) is warranted? In AAPACN’s IPA Algorithm tool, find out the steps you’ll need to take in the event that there is a …
  • Comprehensive Person-Centered Care Plan Audit Tool and Care Planning Cheat Sheet
    The care plan should reflect a resident’s goals for health and wellness, and what the clinical team is doing to help the resident achieve those goals. AAPACN’s §483.21 Comprehensive Person-Centered Care Planning Cheat Sheet provides …
  • PDPM Case-Mix Group Conversion to HIPPS Characters Tool
    The nurse assessment coordinator and team members can easily convert the case-mix groups achieved under the Patient-Driven Payment Model (PDPM) to the five-digit Medicare billing code by using the PDPM Case-Mix Group Conversion to HIPPS …
  • PDPM Game Plan Tool
    The shift to PDPM is more than a one-time change. It’s an ongoing transition that will fundamentally alter how care is delivered, managed, and reimbursed within your facility. There are many tools out there to …
  • Call Light Audit Tool
    Are you checking regularly to ensure your call light process is working according to your policy? Use AADNS’s Call Light Audit Tool to check your system to ensure it is meeting the necessary standards, write …
  • PDPM FY2020: MDS Nurse FTE Calculator Tool
    AANAC has re-released the MDS Nurse FTE Calculator for SNF leaders to estimate the time needed to complete assessments as well as project how many hours the NAC needs for meetings and other duties under the …
  • PDPM Admission Checklist Tool
    Are you prepared to collect the needed information at the time of admission for residents under PDPM? The AAPACN PDPM Admission Checklist Tool can help SNFs collaborate with hospital discharge planners to collect the necessary …
  • NAC Job Description
    The nurse assessment coordinator’s role in ensuring compliance with complex federal requirements is paramount to the success of the financial operations of a facility and the care of residents. Use this NAC Job Description, to …
  • QIES ASAP System Walkthrough and the Key CASPER Management and QM Reports charts
    The QIES ASAP System Walkthrough and the Key CASPER Management and QM Reports charts provide: (1)   A comprehensive walkthrough of the MDS and PBJ data submission components of the QIES ASAP (Assessment Submission And Processing) system, and (2)   The …
  • Infection Preventionist Job Description
    Time is running out – soon it will be a requirement to have an infection preventionist on staff at your facility. Use AADNS’s Infection Preventionist Job Description to help customize your job description for this …
  • Responding to ADRs Tool
    An Additional Development Request or Additional Documentation Request letter can cause a lot of stress in the SNF if there’s not a process in place to respond to it. Use this Responding to ADRs Tool to …
  • Drug Regimen Review Quick Guide
    Help your clinical team to understand the MDS Drug Regimen Review (DRR) process and to identify clinically significant medication issues that need immediate physician follow-up. Use the Drug Regimen Review Quick Guide tool to shore …
  • ADL Nursing Assistant Training
    ADL training is usually an area of focus for facilities in order to maintain the accuracy of ADL coding for section G on the MDS. To help your CNAs document ADLs properly, AANAC has created …
  • Pressure Ulcer Coding Algorithm
    Properly coding pressure ulcers can be tricky. AANAC’s Pressure Ulcer/Injury Coding Algorithm diagrams how you should code or not code present on admission in a variety of scenarios. Reviewed March 11,2020 For permission to use or reproduce …
  • Section G Coding Tool
    Is managing section G and section GG a lot for you and your team? Use AANAC’s Self-Performance Scoring Guide Tool to help keep it straight.   For permission to use or reproduce this tool in full or …
  • Section GG Prior Function and Admission Performance Tool
    Effective Oct. 1, 2018, section GG is growing. You will be required to complete an assessment of every day activity function and device use prior to the current illness or injury. You will also need to work …
  • Survey Readiness 24/7 Toolkit
    AADNS’s Survey Readiness 24/7 Toolkit walks nurse leaders through the new survey process before the surveyors arrive, helping you understand what to expect throughout the new survey process. Most importantly, the guide helps DNSs to …
  • Guide to Successful Restorative Programs
    There are many reasons to beef up your facility’s restorative program, from reducing risk of ADL decline, improving Five-Star and Quality Measure ratings, minimizing risk of falls and immobility, to improving reimbursement and getting ready …
  • Five MDS QA Audit Tools
    As the Survey Process is heating up this summer all over the country, surveyors have their eye on MDS accuracy and the RAI process.  You as a Nurse Assessment Coordinator do not want to be …
  • Pre-Admission Screening Tool
    Do you have one easy tool to collect all of the information that you need about incoming residents? Use AADNS’s Pre-Admission Screening Tool to collect all of the necessary information for prospective or expected admissions. …
  • AANAC’s Potential Candidates for Restorative Program Tool
    Identifying which residents are appropriate candidates for restorative nursing programs is key to helping residents attain and maintain their highest function. Use AANAC’s Potential Candidates for Restorative Program Tool to quickly identify key triggers and prevent …
  • Body of Knowledge for the Director of Nursing Services in LTC
    What does it take to be a successful DNS? AADNS’s Body of Knowledge for the Director of Nursing Services in Long-Term Care identifies, defines, and measures the core competencies required of DNSs practicing in SNFs. …
  • The Life of an ICD-10 Code Tool
    When you select an ICD-10 code, how does it really impact care for each resident throughout his or her stay? Follow Mr. Jones in this short video created in collaboration with AHIMA and find out! For the companion handout, click …
  • Resident Prioritization Tool
    Reducing antipsychotics requires attention to detail each step of the way. Check out this Resident Prioritization Tool, an algorithm and worksheet that guides staff in assessing residents correctly and consistently to target and prioritize reduction …
  • ICD-10 Diagnosis Coding and Communication Tool
    Do you know how to talk to the physician to ensure the proper ICD-10 codes are documented in the medical record? Use the sample queries in AANAC and AHIMA’s ICD-10 Diagnosis Coding and Communication Tool to practice and …
  • ISMP Medication Safety Self Assessment® for High-Alert Medications
    The Institute for Safe Medication Practices has released a Medication Safety Self Assessment® for High-Alert Medications.
  • Regs for NACs Tool
    As the NAC, what regulations become effective Nov. 28, 2017 that will absolutely affect your job?  AANAC’s interactive Regs for NACs quick tool organizes all of the F-Tags and related Interpretive Guidelines from Appendix PP …
  • LTC Survey Pathways Tool
    Are you prepared for the many Facility Tasks, Critical Element Pathways, and Care Areas that are in effect November 28, 2017? Use this quick LTC Survey Pathways Tool to assign departments and actions needed now.  …
  • Baseline Care Plan Tool
    The revisions to Appendix PP focus on resident’s rights for person-centered, individualized care. The resident has the right to: Be informed and participate in his or her treatment in a language that he or she …
  • Alarm Reduction Idea List
    A new laser focus has been trained on the world of restraints and alarms. Download and print this list of ideas to help nursing home leaders tackle alarm reduction. Want to learn more about alarm use and …
  • §483.70(e), At a Glance Guide to Facility Assessment Considerations
    There is a lot to consider when it comes to the facility assessment, required November 28, 2017. Get ahead start with this At a Glance Guide to Facility Assessment Considerations. For permission to use or …
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