We adopted a 24/7 visitor policy after much encouragement. Unfortunately, we occasionally get disruptive visitors. What can we do to restrict this without receiving complaints?

Your circumstances illustrate the intersection of multiple resident rights, all protected under federal requirements for long-term care facilities that participate in Medicare: the right to respect and dignity, the right to privacy, and the right to receive visitors of their choosing at the time of their choosing (42 C.F.R. 483.10). 

Your state also may have a law echoing and/or expanding on these rights. Illinois, for example, enshrines resident rights in its Nursing Home Care Act.

Under the LTC Medicare Requirements, the type of protected visitation varies by the type of visitor. State and Medicare representatives, a resident’s physician, and a resident’s representative must be given immediate access. Subject to the resident’s consent, the resident’s family and relatives must be given immediate access; other visitors must be given immediate access subject to reasonable clinical and safety restrictions; and individuals providing health, social or legal services must be given reasonable access. 

Facilities must publish visitation policies that clearly state (1) any clinically necessary or reasonable restrictions to visitation; (2) when such limitations apply; and (3) that the facility may need to impose restrictions on visits for clinical or safety reasons.

And yet a resident’s right to visitors does not protect visitations that impose on the rights of another resident. You may elect to curb disruptions to other residents by adopting visiting hours, but only with the understanding that certain visitors must always retain the right to immediate access, subject to the resident’s consent.  

A North Carolina hospital will have to go to trial over claims that it fired at least three employees who refused a flu shot on religious grounds. 

Mission Hospital Inc. refutes the claims, arguing the workers weren’t fired for their religious beliefs, but rather for failing to follow the hospital’s accommodation procedure and deadlines. 

The hospital’s motion to dismiss the case was denied in August. The case will proceed to a jury trial, where there are “genuine issues of material face” and a jury could side with either party, according to the court’s opinion. 

Salaries for nursing home administrators jumped 3% over the past year, to a national average of $97,401, while directors of nursing realized a 2.6% increase, to an average of $89,902.

The Nursing Home Salary & Benefits Report 2017-2018 was released in late July and is the largest nursing home survey of its kind.

Executive directors and chief financial officers for skilled nursing facilities experienced salary boosts of 2.5% and 2.1%, respectively. Both positions earned less than their counterparts in continuing care retirement communities, report results revealed. 

The average salary for assistant DONs rose 2.3%, to $71,474.

On an hourly basis, pay for registered nurses rose 3.3%, to $27.52 per hour; LPNs, 2.65% to $21.26;  CNAs, less than 1.5% to $12.62; and non-certified nurse aides 3.5%, for an average rate of $10.90.

The report is published by Hospital & Healthcare Compensation Service in cooperation with LeadingAge and support from the American Health Care Association.

The Centers for Medicare & Medicaid Services issued a proposal in mid-August to cancel its Episode Payment and Cardiac Rehabilitation bundled payment models, citing a need for “greater flexibility” in designing new models.

The agency also proposed cutting the number of mandatory geographic participation areas for its Comprehensive Care for Joint Replacement model from 67 to 34. Providers in the remaining areas would be allowed to participate in the model on a voluntary basis.

“These changes … give CMS maximum flexibility to test other episode-based models that will bring about innovation and provide better care for Medicare beneficiaries,” CMS Administrator Seema Verma said.

CMS also noted that the proposal marks what it expects to be the start of more voluntary, as opposed to mandatory, payment initiatives. Comments on the proposals are due by Oct. 16.

As providers prepare for Phase 2 requirements under the Centers for Medicare & Medicaid Services’ mega-rule, many are balancing how to stay compliant while affirming residents’ rights.Attorney Sean Fahey, of Hall, Render, Killian, Heath & Lyman P.C., will give guidance on this and more during the Quality session of the McKnight’s Fall Online Expo. 

Fahey’s session will start at 1 p.m. ET on Sept. 20, and is one of three sessions that day. Attendees can receive up to three CE credits and are encouraged to visit the virtual exhibit hall.

Register for the fully free event at www.mcknights.com/FallExpo2017. 

President Trump may have struggled mightily to kill Obamacare. But he is clearly enjoying early success in at least one area: labor policy.

And if you happen to be running a long-term care facility, the trade winds here continue to be favorable.

Consider the persuader rule. The measure was introduced last year by the Obama administration as a way to force nursing homes and other employers to report all communication with attorneys and consultants related to unionization efforts.

Operators quickly complained that the decree undermined both the attorney-client privilege and the privacy of consultant relationships ensured by the Labor-Management Reporting and Disclosure Act.

In November, a Texas federal court put the order on hold by issuing a permanent injunction. But the Trump administration appears to have its own kind of permanent injunction in mind: In June, the Labor Department called for the rule to be rescinded.

Then there’s the National Labor Relations Board. In July, the Senate’s Health, Education, Labor and Pensions Committee approved the addition of two Republicans to the panel, which referees labor disputes. Going forward, care to guess whether management or labor will be getting a favorable thumb on the scale?

The Labor Department is also efforting to trim Obama-era plans to expand overtime eligibility. Moreover, the government is now supporting the employers’ position in a Supreme Court case on mandatory arbitration agreements that prohibit workers from filing class-action lawsuits.

It’s hardly surprising that a Republican White House would adopt a pro-business approach. And few nursing home operators are going to complain.

But there is a certain amount of irony at play here. After all, many of the people who will be negatively affected by these changes happened to vote for Trump. 

To be sure, their investment return may leave a bit to be desired. But as the saying goes, politics makes for strange bedfellows. 

Health literacy is lacking for individuals with Medigap coverage compared to other elderly populations, new research has found.

Health literacy is whether a patient can obtain, process and understand basic health information in order to manage his or her health. Nurses and community health workers often lead programs that try to increase health literacy with education about medication labels, consent forms or advanced directives. Other approaches can include counseling, tutorials, telephone outreach or medical visits.

Efforts should target sicker, older adults, especially those who are male, less educated and in poorer health with more chronic conditions, according to analysts at Optum, UnitedHealthcare and AARP. 

Those with low health literacy may have reduced cognitive functioning or poor decision-making ability, and are more likely to not exercise, exhibit poor self-care, have more chronic conditions and overall poorer physical health. They also are less likely to receive screenings or other preventative services. 

Results appeared in the July/August issue of Geriatric Nursing. 

Nurses showed short- and long-term benefits after just three hours of an assertiveness training program, according to results from a University of Miyazaki study.

Study participants received two 90-minute training sessions a month apart. The sessions consisted of lecture and small group role play. 

After the training, the mean total RAS score, used to measure assertiveness, improved from -14.2 to -8.9. The program moved participants inside the optimal range for Japanese nurses of -10 to 10 said Naoki Yoshinaga, Ph.D., MSN, study author and lecturer at the University of Miyazaki in Japan. His specialties include practice of cognitive behavioral therapy.

One of the study authors, Sayoko Nakamura, a nurse risk manager at a university hospital, noticed that poor communication among nurses was a main cause of reported incidents for nursing practice errors, Yoshinaga said. That compelled researchers to explore assertiveness training for nurses at Nakamura’s hospital. 

“It’s important that employers make nursing staff recognize the necessity of improving assertiveness so that they have high motivation and are willing to participate in assertiveness training in order to reduce interpersonal stress, build effective team relationships and provide sufficient nursing care,” he said. 

I’m feeling a bit overwhelmed. Do you have any tips to assist with the new survey process?

I suggest you use the Critical Element Pathways (CEPs) that the Centers for Medicare & Medicaid Services adapted from the original Quality Indicator Survey. The CEPs are questionnaires and observational checklists that surveyors will use to guide the interactions between the survey team and your care staff during the new process. 

Read and review all the CEPs. The nonclinical CEPs in particular can help you to identify areas of potentially deficient practice that may be suspected during the survey. 

Crosswalk the clinical CEPs to applicable policies. When preparing for staff education, attach the CEPs to the applicable policies and/or procedures. This will help your staff connect the dots between your facility process and the federal requirements. 

Educate your nurse leaders on how to use CEPs. This includes unit managers, MDS nurses, shift leaders, and the in-service director. Empower them to take ownership of the training for areas they are in charge of, critiquing and improving their training methods to include relevant CEP guidance. 

Regroup with your nurse leaders to assess potential knowledge gaps. Ask the following questions: 

• Were any gaps in policies or procedures identified during training? 

• How often will the staff need to be retrained per the CEP guidance — annually, or more frequently? 

• Do we need to refer to QAPI for a possible audit tool or workflow adjustment?

By effectively incorporating the guidance provided by the CEPs into your staff education, you will expose your nursing department to the surveyors’ perspective of the new survey process, which will greatly help to prepare your team for your next survey.

Ten Florida skilled nursing facilities have filed a class-action lawsuit against several insurance companies over their alleged failure to pay interest on overdue Medicaid payments. 

The suit names as defendants seven managed care companies, including affiliates of Humana, Molina Healthcare and United Healthcare.

The 21-page complaint, filed in August in the U.S. District Court for the Southern District of Florida, states that the plaintiffs “provide healthcare services to some of Florida’s most vulnerable citizens” including the elderly and individuals with disabilities, many of whom require 24-hour complex medical care and suffer from cognitive impairments like Alzheimer’s.

The lawsuit alleges that despite the SNFs providing proper claims for payment as outlined in their managed care contracts, the Medicaid managed care organizations “engaged in a pattern and practice of fabricating reasons to delay payments of claims to plaintiffs, and then paying an improper amount of interest, if any, on overdue payments.” 

Payments delivered after the deadline typically accrue interest at 12% per year.

The Florida Health Care Association, which has testified in the Florida Senate in support of the nursing home providers, has determined that many facilities carry more than $200,000 in outstanding claims, leading to a statewide shortfall of $135 million.

The SNFs argue the insurance companies’ failure to pay interest on overdue claims has hindered their ability to provide certain services to Florida residents.

The lawsuit was brought against the managed care groups on behalf of the SNFs and “all other Medicaid providers similarly situated,” according to the complaint. The providers are seeking declaratory, monetary and other appropriate relief, court filings show.