In addition, more than 3 in 4 said they still were relying on expensive temporary agency staff or extra overtime shifts to fill vacant posts. Survey findings were released in early June in conjunction with the American Health Care Association’s 2023 Congressional Briefing in Washington, DC.

More than 1 in 4 (26%) responding providers said they were “very concerned” they will have to close their facility because of persistent workforce challenges. Overall, 90% of providers are increasing wages and 85% are offering bonuses, per responses gathered in May.

“We’re finally getting to the point where frontline care workers are earning a living wage, but the problem is that state legislators in every state have not kept up with those increases and inflation in the corresponding Medicaid rates,” said AHCA President and CEO Mark Parkinson.

Nursing homes and home health providers too often have been receiving patients with conditions they are not prepared for, putting both care providers and patients at risk, the Centers for Medicare & Medicaid Services warned state survey agency directors.

Post-acute providers might not be equipped or trained properly to care for newly admitted patients without full information. Some specific “areas of concern” are “missing or inaccurate information” related to patients with serious mental illness, complex behavioral needs or substance abuse problems. 

Underlying diagnoses related to the mental illness or substance abuse; full information about specific hospital treatments; and medication lists also have been incomplete, CMS said, listing at least a dozen other hospital information shortcomings. 

A: Many tasks that are needed to safely care for residents are behind a computer. The goal of this study was to look carefully at what kind of clinical support well-trained nurses with nursing home experience, who have access to residents’ electronic medical records, can provide virtually to support clinical care in the facility.

Q: Why off-site oversight?

A: We are always thinking about all the work clinical staff does in the nursing homes. They’re working in a system that doesn’t always support good care processes. What can be done by someone not physically in the building? Nurses who have access to electronic records — what can they do to support care? How can they serve up clinical recommendations so they can immediately be put into action?

Q: Were there any potential concerns with using more technology?

A: We want to create supportive tools that layer in with existing nursing workflow and are something that they can pick up and run to improve resident care. It’s not a supportive service if you’re taking up more time. … Also, trust among team members is essential to achieve desired outcomes, and it can be even more challenging when the team members are not proximal to each other.

Q: What kind of gaps can be filled?

In addition to medication monitoring, if, for example, the discharge summary from the hospital notes a wound, the appearance and condition of the wound as well as care orders need to be clearly documented upon admission. If this information is not in the long-term care facility’s system right away, it can lead to problems later.

Kathleen T. Unroe, MD, MHA is with the Regenstrief Institute and Indiana University School of Medicine.

A: You are understanding correctly, as routinely changing Foley catheters is an outdated practice. Unfortunately, this outdated practice still exists in many facilities. I suggest you look at CAUTI bundle compliance, along with a rounding tool. 

Bundle (ABCDE) Checklist for Prevention of CAUTIs

• Hand hygiene: It is the most important factor in preventing nosocomial infections.

• Aseptic catheter insertion procedure.

• Proper Foley catheter maintenance, education, and care by nursing staff.

• Foley catheter use surveillance and feedback

Urotoday.com also offers resources to help you with the ABCDEs of catheters and catheter care; it’s quite helpful. Perhaps your infection preventionist can add a rounding to check the condition of Foleys and identify maintenance needs. 

Ask a care team member if the Foley is still warranted or if a patient could be weaned. 

Get your team involved so that the numbers of catheters, their maintenance and the rounding needed to monitor them is a team approach and everyone is involved. 

Make it a team goal through your QAPI meetings to reduce the number of catheters if you think, or know, the number of Foley catheters is higher than normal for your census.

As a leader, when you see the need for a change to improve the quality of care and or life at your facility, it is your responsibility to start the ball rolling, no matter if a regulation is or is not involved. It’s the right thing to do.

Sherrie Dornberger, RN, CDONA, FACDONA, is executive director of NADONA. Send her your resident care questions at ltcnews@mcknights.com.

The Food and Drug Administration in May approved the first drug to treat agitation related to Alzheimer’s disease dementia. Patient advocates hailed the news, but prescribing the drug, an antipsychotic, may put long-term care clinicians in a bind.

The approval is an added indication for Rexulti (brexpiprazole), which is also used for treating schizophrenia. Clinical trial participants who took 2 mg or 3 mg daily showed a 31% greater reduction in the frequency of agitation symptoms.

Agitation related to dementia is among the most common causes for placement in skilled nursing facilities and is a quality of life issue for facility residents. Yet Centers for Medicare & Medicaid Services requirements to report antipsychotic use for treating Alzheimer’s symptoms can leave clinicians at risk of looking less responsible to consumers when the data is publicly reported. The issue has become more urgent as more facilities admit residents with behavioral health issues, and new medications that can benefit residents are approved.

CMS convened a technical expert panel to review the issue. In the meantime, providers likely will take caution when deciding to prescribe the recommended Rexulti dose of 2 mg, which can be increased to 3 mg.

A:  A punitive environment can be minimized with a proactive approach of care and by maintaining standards of practices. The F-tag F 686 is for skin failure and includes F 483.25 (b) for skin integrity and F 483.25 (b) (1)for pressure ulcers. 

The intent from the Centers for Medicare & Medicaid Services is that a resident does not develop pressure ulcers or skin injury unless it is clinically unavoidable, and the facility provides care services that maintain the professional standards of care. 

Multiple risk factors including age, dry skin, previous sun exposure, multiple medications and systemic factors including co-morbidities, can make skin injury unavoidable. As we age, subcutaneous fat decreases, and elasticity of the skin, vascularity, Langerhans cells (the fighter cells in the skin), sweat glands, and thermoregulation are all altered. This leads to weaker skin. Dry skin is one of the most common factors for skin breakdown, and excessive moisture and sweat can cause skin excoriation. 

The history of sun exposure can lead to photoaging. Signs include hyperpigmented skin, fine veins on the surface of sun exposed skin, freckles (melasma), and actinic or seborrheic keratosis. Medications, including some diuretics, antibiotics and local or systemic steroids, also can cause photosensitivity and skin reactions. 

Other risk factors, such as excessive adipose deposition, chronic conditions, acute systemic infections and even stress (which leads to an increase in steroid hormones) can lead to skin damage with the slightest risk for skin integrity. 

 A proactive approach including assessment for risk factors of unavoidable skin breakdown, as well as timely and comprehensive documentation, are the first steps for standards of practice.

Fatima Naqvi, MD, CMD, is medical director of AMDA – The Society for Post-Acute and Long-Term Care Medicine. Send her your wounds-related questions at ltcnews@mcknights.com.

“The use of antimicrobials to treat infection in these wounds is prevalent, but there is now an imperative to align treatment with reducing antimicrobial resistance and antimicrobial stewardship,” Karen Ousey, a professor of skin integrity and chair of the International Wound Infection Institute UK, wrote in June’s Journal of Wound Care.

Researchers reviewed 178 studies to identify criteria for ideal post-surgical wound dressings to overcome infection while supporting stewardship objectives.

Antimicrobial wound dressings can be especially helpful in preventing infection of surgical wounds, and in some cases, they may replace the use of systemic antibiotics. However, the authors noted, the dressings must be closely monitored in case the wound fails to respond. Providers can also consider non-antibiotic antimicrobials including silver, povidone-iodine and cadexomer iodine. 

The ink, developed by researchers in China, can be spread into a cut of any shape. It has been shown to bring wounds in mice close to closure in 12 days, the developers reported in ACS Applied Materials & Interfaces. 

The PAINT, or “portable bioactive ink for tissue healing,” system uses white blood cells, or extracellular vesicles, combined with sodium alginate. The ingredients mix at the pen’s tip and form a sturdy gel at the site of an injury within three minutes of being applied. 

The extracellular vesicles promote blood vessel formation and reduce inflammatory markers in human epithelial cells, shifting them into the “proliferative,” or growth, phase of healing, researchers said.

PAINT (pictured above) also promoted collagen fiber formation in mice, the researchers noted. They reported the tool could help heal a wide variety of skin injuries quickly and easily, without the need for complex procedures.

Interventions aimed at reducing work-related stress for nurses may lead to improvements in how people cope with stress up to a year later, according to Dutch researchers at Amsterdam University Medical Centre.

Investigators examined 117 studies of the effects of different interventions on stress alleviation, which involved more than 11,000 healthcare workers worldwide. 

They considered interventions focusing attention either on the experience of stress, or away from the experience of stress, such as cognitive behavioral therapy, assertiveness training, coping and communication skills, meditation, yoga, massage, acupuncture and more. The goal was to determine whether these interventions helped reduce stress.

Study participants were experiencing low to moderate levels of stress and burnout, as well as depression, anxiety, impaired concentration and emotional and relationship problems. Results showed that reducing healthcare workers’ stress “may be beneficial for the healthcare workers themselves and it may spill over to the patients they care for, and the organizations they work for,” said Sietske Tamminga, PhD, lead author and assistant professor in public and occupational health at Amsterdam University Medical Centre. “Employers should not hesitate to facilitate a range of stress interventions for their employees.”

Full findings appeared in the Cochrane Database of Systematic Reviews.

Previous studies have shown that stress reduction activities have led to greater work satisfaction and productivity, as well as improved patient outcomes. 

A: Fraud is deception intended to result in financial or personal gain. It includes false representations, false statements or concealing information. The Office of Inspector General maintains a website and hotline where the public can submit complaints and report suspected fraud. 

The RAI User’s Manual offers definitive guidance. To seek payment, conditions must be coded accurately — which includes meeting all criteria from the instructions. If circumstances do not satisfy all criteria, do not code them.

For example, if a resident does not satisfy all four criteria for isolation, knowingly coding isolation to achieve a higher case-mix classification would constitute fraud. Alternatively, asking a physician for an unsupported diagnosis to exclude the resident from a quality measure could also be fraud. Both scenarios involve presenting false representations for gain. 

The MDS attestations require individuals coding the MDS to sign. The RAI manual states, “Legally, it is an attestation of accuracy with the primary responsibility for its accuracy with the person selecting the MDS item response.” It warns those signing that “the information you entered on the MDS, to the best of your knowledge, most accurately reflects the resident’s status. Penalties may be applied for submitting false information.” 

Human error occurs and coding discrepancies do happen. When an MDS inaccuracy emerges, follow the RAI User’s Manual instructions. It requires modification of that MDS within 14 days of discovery. Concealing errors to avoid repayment would be another form of fraud.

Whether an intentional falsehood or a concealed mistake that goes uncorrected, presenting false information for gain constitutes fraud. 

Amy Stewart, MSN, RN, RAC-MT, RAC-MTA, DNS-MT, QCP-MT, is vice president of education and certification strategy for AAPACN. Send her your nursing questions at ltcnews@mcknights.com.