The report found there was a higher proportion of SNF residents diagnosed with respiratory illnesses for fiscal year 2020 when compared to 2019 and 2018. Investigators also found increases in speech-language pathology and nursing case-mix indices for both COVID-19 and non-COVID-19  patients. 

“Our results indicate that it is hard to disentangle the impacts of the transition to the new payment system and the impacts of the COVID-19 pandemic,” co-author Melissa Morley told McKnight’s Long-Term Care News. She stressed the need “to consider the impact of the pandemic on the non-COVID patient population as CMS evaluates the transition to PDPM.”

CMS was expected to issue updated guidance, likely in time for the Oct. 1 start of the new fiscal year.

A:Resident activities are still viewed as “nice to have” and “fun” with no benchmarks to prove return on investment. The Resident Engagement Institute, led by Linked Senior, will offer participants immediate access to quality education, individualized consulting, publications about best practices, evidence-based statistics, and assistance with product development and improvement.

Q: Why is it important to long-term care and its employees?

A:As we begin to rebuild from COVID-19, it is time to rethink strategies across the board so residents receive consistent, preference-based engagement…. This kind of culture can improve clinical and quality outcomes; increase length of stay and revenue while reducing rehospitalizations; and decrease staff turnover.

Q: How do providers benefit?

A:The Institute will provide care partners new tools and the opportunity to engage and consult directly with experts and help them measure the satisfaction and well-being of their residents. The work of the Institute will show that resident engagement has a correlation with providers’ return on investment needs.

What many long-term care staff members have is PRESENTEEISM. Signs can include:

• Making more mistakes than normal

• Producing work of lowered standards

• Lower productivity

• Reduced attention to detail

• Arriving late or leaving early

• Missing lunch breaks and or working long hours

• Working while sick

• Looking tired/exhausted

Recruiting and retaining staff right now is a huge undertaking. Facilities are offering sign-on bonuses and all sorts of incentives.

It may also help to have your facility approved as a clinical site for CNA, RN and LPN programs. When they come in for a tour, ask clinical instructors to meet with students during a pre- or post-conference. Buy snacks or lunch for them, and take applications. 

If you don’t already have a nursing student category for those in an RN program, consider a different level for them than a standard CNA. Consider a clinical ladder. For instance, if staff become certified in ALS or IVs, they may climb the ladder, and perhaps get a raise or extra PTO/vacation time. 

Money is not the only incentive! Extra time off, massages and pedicure/manicures also work. Consider working with a nearby daycare to also assist staff with those needs, possibly at a reduced rate or with facility support.

Think out of the box. Ask your employees what they would like as an incentive, and let them know you care.

Skin tears are most common in the elderly as a result of thinning of skin that occurs with age.

Certain conditions, such as chronic steroid use, a history of smoking, dry skin and malnutrition, increase the risk of them. 

Skin tears usually result from trauma such as bumping into furniture, shear trauma during transfers or from tape from briefs or wound dressings.

Tears can be minimized by gentle handling and using draw sheets to reposition residents in beds. Excellent general skin care such as bathing with a pH-balanced skin cleanser, blotting skin dry and moisturizing with an emollient cream and adequate hydration also helps. Protective sleeves and securing dressings with an elastic wrap instead of tape also minimizes risk.

Most skin tears are partial thickness, involving separation of the upper layer of skin. It is important to gently clean a new skin tear with wound cleanser and to reapproximate the skin flap into place. Larger or deeper skin tears may require wound closure strips.

Covering the skin tear with either Vaseline gauze and a foam dressing or a transparent, vapor-permeable dressing protects the wound as it heals.

The healthcare practitioner should be notified of skin tears, and a wound nurse or specialist may be required if the skin tear is more than a few centimeters in size or if the wound is deeper than the uppermost layer. 

You should monitor the skin tear as it heals and alert the healthcare practitioner if there is an increase in the amount of drainage, if the area bleeds or if there is pus or a foul odor.

The timing of dressing changes also should be done according to the type of dressing selected.

— Mary P. Evans, M.D., CMD, CWSP

Under the Patient Driven Payment Model, cognitive level is identified through completion of the Brief Interview for Mental Status (BIMS) or the Staff Assessment for Mental Status.

If the interview or assessment indicates the individual is cognitively impaired, the speech-language portion of the PDPM daily rate is increased. What documentation, if any, is needed to support this information on the MDS? You may be thinking that the interview stands alone, and you’d be right — to an extent. The interview sections of the MDS don’t require additional supporting documentation because answers are provided directly by the resident. What is necessary, however, is evidence that the interview was conducted according to the Resident Assessment Instrument (RAI) requirements. The interview should be conducted within the look-back period, preferably the day before or the day of the Assessment Reference Date (ARD); This is where Z0400 comes in. Z0400 provides the signatures of persons completing the assessment and also houses the date a specific MDS section is completed.

If the BIMS is signed as complete at Z0400 on a date after the ARD, reviewers will likely invalidate the interview, score the BIMS as 15 to indicate normal cognition, and recalculate the SLP component. You may be able to rebut  this type of overpayment audit finding by presenting alternative documentation, but every attempt should be made to enter interview data into the MDS on the day of collection.

The RAI also provides the following guidance: If a staff member cannot sign Z0400 on the same day that he or she completed a section, when the staff member signs, use the date the item was completed.

A company that repairs your premises can be made legally responsible for damages caused by their poor quality work that causes injury to your residents, staff or visitors.

This should be stated in the contract with the repair company, making terms clear it has liability to individuals who are injured due to their poor workmanship or outcomes.

Your contract with it should also specify that they are also liable for fines imposed by federal, state or local governments imposed because of their poor- quality work.

You should get copies of its insurance policies so you can make sure the level and types of coverage are sufficient to protect the facility and that the insurance company is highly rated. 

You may want to have any contractor add your organization as an additional insured to its policy with the legal right to bring a claim on behalf of injured parties so that you have a better position to protect your organization. 

You also should check with your insurance carriers to make certain your position as an additional insured does not disrupt or impact your insurance coverage.  

And don’t overlook this: A contract with a company performing work should state that the company will comply with an express duty to satisfy all federal, state and local regulations. You do not want to ultimately be held responsible for something that another party should be owning up to. 

With a future quality measure focused on avoiding healthcare-acquired infections requiring resident hospitalizations, the infection preventionist role is more vital than ever. The IP should not only participate in tracking infections that occur, but also look for ways to improve systems and processes to avoid infections altogether. 

Have the IP review all infection prevention and control policies to ensure they meet regulatory requirements and evidence-based practice. The pandemic underscored the need to revisit policies that were infrequently updated. A review allows facilities to identify needed improvements, address potential issues and educate. 

After policy revisions, have the IP examine staff competencies. The IP should be the expert educator for all things infection control. Often, nurse leaders focus on the obvious, like hand hygiene or donning and doffing personal protective equipment of frequent citations. Yet another key area of education is cleaning of medical supplies and kitchen and food-related items. 

The IP should oversee vaccinations and ensure education, equipment, and consents are obtained, and that all vaccinations are properly documented.

Many facilities’ QAPI efforts include infection control issues; a dedicated IP can refine and lead them. For example, the IP should spearhead documentation efforts, education and reporting to the National Health Safety Network.

Lastly, the IP can help mitigate risks that often prompt survey citations, litigation, and resident/family concerns. These are costly and time-consuming to correct, but having a full-time IP can help forestall such issues before they arise. 

That said, be mindful of the remnant vulnerabilities COVID-19 left behind, experts warn. One is a false sense of security. 

“The biggest risk is relaxing restrictions too quickly before we achieve herd immunity,” said Majd Alwan, senior vice president of technology and business strategy and executive director of the LeadingAge Center for Aging Services Technologies.

The early reopening scenario  could put the burden of verifying vaccination status on providers and their staff while exposing unvaccinated people to infection and facilitating virus spread, he added.  An AARP analysis recently cited unvaccinated visitors and staff as a catalyst for ongoing nursing home cases.

Opening up too fast also exposes facilities to potential cyberattacks. 

“This obviously increased potential vulnerabilities, especially on personal devices that are less managed and less monitored, leaving organizations more exposed to hacking, phishing, ransomware, and other cybersecurity attacks,” Alwan added, suggesting “more secure” and “trusted” discussion platforms like HealthJay and the Selfhelp Virtual Senior Center.

2. Consider these tips for keeping your guard up in the downshifting COVID-19 era, Wilmink said. Thwart the infection as soon as it rears its head. For example, Wilmink’s own facility-based research found digital contact tracing to be the most efficient in controlling and stopping secondary transmissions of the virus by over 52%. Protect residents without life-limiting measures. Adopt an overall preventive, proactive approach. 

“Shifting the care paradigm from reactive to proactive yields the best results,” he added.

3. Providers would do well to invest in COVID-19 tested resident tech.

One service that could gain quick adoption and popularity are facial recognition scanners that combine temperature-reading and mask-recognition capabilities.

“These were excellent examples of a technology response that offered value, both during but now even following the pandemic,” said Andrew Carle, adjunct faculty member of the Georgetown University curricula in Senior Living Administration.

“Employees shouldn’t be coming to work with a fever at any time, but often don’t recognize the severity of an illness or decide to try to work through it,” he said.

Visitor management tech, meanwhile, offers a host of new applications like health screening, face recognition, mobile-based QR coding, integration with real-time tracking for contact tracing, and touchless interactions like body temperature readings using infrared or thermal imaging, and automated data collection like informed consent, added Alwan.

Finally, cutting-edge rapid testing technology got a shot in the arm during COVID-19, and it offers a host of new resident security applications, as Rochester, NY, provider Friendly Senior Living discovered when it developed a proprietary, low-cost lab electronic medical record. 

It can process rapid COVID-19 tests, reduce staff hours involved and be used to comply with state reporting requirements. 

The innovation has saved the organization over $1 million, said Joel Snyder, director of information technology.

4. Going forward, it will be critical for providers to forge a balance between resident safety and freedom.

In the meantime, expect restrictions to remain a part of everyday nursing home life.

“They’re likely to either become regulatory compulsory or best management practice,” said Patrick Hardy, president of disaster management firm Hytropy. 

Hardy believes guest check-in, often provided at least in part by kiosks, will remain compulsory.

 He also foresees better engineering controls, physical changes to support more private rooms, smaller communal dining with greater distancing and social activities that require less physical interaction.

“Security and freedom go hand in hand,” added Troy Dayon, president of Stanley Healthcare. “A safe environment is what enables wellbeing and the freedom to socialize, spend time with family and whatever else provides meaning in residents’ lives.”

Dayon sees four emerging trends: A shift from reactive to proactive, as providers learn to use technology to stay ahead of problems; AI, machine learning and other data-driven tech that will develop more targeted-inspired or generated personal care plans, and other individualized measures; new technology that will maximize caregiver effectiveness; and resiliency to be ready for future risks by building in flexibility in how communities deliver care to seniors.

The related turbulence delayed the building’s unveiling until February, but the organization remained focused on putting its stamp on skilled nursing and post-acute care. Its 77,000-square-foot, $25 million facility in Lakeland, FL, offers 120 beds with 32 private and 47 semi-private rooms. It provides full rehabilitation and a complement of therapies in an environment designed to help residents and patients feel like they are at a healthcare resort, says executive director Mike Bradley.

“The many challenges the pandemic caused have certainly flowed into the opening of this facility,” Bradley says. “One example is we were not able to have the traditional open house. We had to limit the amount of people that could attend at any one time to remain compliant with CDC recommendations.”

Nevertheless, the freshly opened SNF and rehab center are working to gain an advantage in the competitive, post-acute care landscape. At the heart of the center’s strategy is offering intensive clinical services and high-tech features within a luxury setting.

“The facility’s use of space, technology advances and spa-like amenities have raised the bar considerably,” Bradley says. “The large smart-enabled televisions, enhanced call light system, top-of-the-line therapy equipment, combined with the resort amenities of beauty spas, movie theaters and chef-prepared culinary experiences set us apart.”

For intensive clinical services, the physical therapy suite includes specialized orthopedic, cardiac and stroke rehabilitation programs, along with physical, occupational and speech therapies. The new health and rehab center is also totally electronic, with all records organized and stored digitally. The semi-private rooms were designed to be what Bradley calls “a butterfly suite, where each resident has individual space, including a window and the ability to be truly separate from roommates.”

Promoting tranquility

The aesthetic and functional design of Lake Gibson Health and Rehabilitation Center was created to promote an atmosphere of tranquility and relaxation, Bradley says. Lush landscaping with calming, cascading waterfalls are hallmarks of the Florida-inspired décor. Views of the tropical courtyard are accessible throughout the building and are the aesthetic centerpiece of the design, Bradley says.

“The resort atmosphere in the facility is apparent as soon as you enter,” he says. “The lobby is designed in a way to both be inviting and opulent. It is an environment that is conducive to wellness and peace.”