The current reporting system “hampers law enforcement efforts to address substandard care,” said the diverse attorneys general group in a letter to Centers for Medicare & Medicaid Services Administrator Chiquita Brooks-LaSure.

Meanwhile, a CMS official said during a stakeholder call that the group was eager to start leveraging data that would be collected under the proposed rule that elicited the AGs’ comments.

The issuance of a final rule was imminent as of press time.

As proposed in February, the rule would define private equity and real estate investment trusts, which regulators said would set the stage for the disclosure of whether those types of owners or investors play a role in a specific nursing home.

A: The credentials are designed for any post-acute leader desiring to determine their level of mastery of advance practice content. We have used the same domains of practice that apply to licensure; however, the level of complexity is significantly greater. We have had significant interest from members, especially in the months leading up to the launch at our 56th Annual Convocation and Expo in late April. 

Q: What does the program entail?

A: The certification exam includes a 100-question “core” exam, along with the option of two lines of service, one each for skilled nursing and assisted living. The Certified Nursing Home Administrator exam is based on the exam blueprint developed by the ACHCA Certification Committee, subject matter experts, as well as the four domains of practice as set forth by the National Association of Boards of Examiners. These areas are Care Services and Supports, Operations, Environment and Quality, and Leadership and Strategy. Each line of service exam is 50 questions.  

Q: How can credentialing help drive improvements in individual buildings and across the sector?

A: These credentials exemplify an advanced level of practice. For the individual, the exam helps them understand areas they may need additional continuing education in and sets forth a clear path for their personal professional development plan. For the profession, when administrators are practicing at the top of their license, the communities in which they lead can produce better outcomes in each of the domains mentioned above. That translates to better care and more cost-effective results for payors. (Learn more at www.achca.org/certification.)

A: You don’t have to do it all alone!

Think about some of the best training you have received, and try recreating some of it. Skills labs are popular with staff. Set up a room with blood pressure stations, a weigh station and more. and have nurse aides go through the stations.

Set up a room with 10 things that are wrong — maybe a frayed call light, items on the floor, pills on the bedside table — and have staff list the items that should not be there or are dangerous. Or send emails to your consultants, medical director, dietitian and social worker, and give them a month during the year that you would like them to conduct an in-service. 

For instance, perhaps ask the dietitian to talk about proper seating and feeding of the resident. Ask podiatry to speak on care of the feet. A pharmacy consultant can perhaps address flexible medication times. Also involve the social worker, funeral director, local politician and administrator.

Do you have nurses who are certified in wound care or infection prevention? Include them, too. This way, lots of people make your work lighter. 

Activities can get involved, too, talking about activities and how they involve residents and perhaps their family members in selecting appropriate activities for the specific residents. These session can provide new lessons for consultants too, as the staff know their residents well and can make suggestions to improve the quality of life for those under their care.

Make it fun. Serve refreshments when you can, and more will attend! Oh, and don’t make all of the training at 2 p.m. just to make it easy for the consultants. Juggle the times so all shifts have equal opportunities to attend during their waking hours.

A: Literature and research supports the use of antibiotics when deemed appropriate, though unnecessary use can lead to antibiotic resistance and development of MRSA and VRE. Where  does one draw the line in post-surgical wound care for older adults when the risk of infection is higher,  compared to younger individuals with fewer comorbidities?

The situation can be more complex when leaders are striving to maintain Quality Assurance and Performance Improvement standards for antibiotic usage.

It’s critical to understand each patient’s individual infection risks. 

Factors that predispose a person to develop infection include patient characteristics such as uncontrolled diabetes, smoking status, excessive deposition of adipose tissue, and autoimmune disorders that can lead to immune deficiency. Pre-operative risk factors also can factor in, such as when a patient with uncontrolled diabetes or hypertension needs an emergency hip replacement.

Then there is a suboptimal aseptic environment caused by  improper hand hygiene or skin preparation prior to the surgery. Post surgical risk factors may involve all of the above and the inability to mobilize early, excessive moisture or dryness, improper wound care and the inability to differentiate between inflammation during the healing process and development of infection.

Standards of care practices guide us toward initiation of the antibiotics when appropriate with the duration of the therapy.

Key factors for early detection and prompt intervention are to know your patient as a person, and to assess and examine them and their wounds at the time of admission. Timely follow-up with accurate documentation is doing the right thing at the right time. 

Using dual-energy X-ray absorptiometry, researchers diagnosed sarcopenia in 81 of 217 Chinese wound clinic patients. Tracking over a five-year period revealed age, sarcopenia and high creatinine levels to be the greatest factors contributing to mortality.

But after estimating mortality for patients with each condition, they found survival among those with sarcopenia was significantly lower than non-sarcopenia patients.

“Active prevention and improvement of sarcopenia can potentially improve the survival outcomes of this patient population,” authors from the First Affiliated Hospital of Chongqing Medical University and the University of Chinese Academy of Sciences noted in the April issue of Frontiers in Nutrition.

Sarcopenia is estimated to affect 15% of adults over the age of 60, and 46% of those aged 80 and older. A separate study recently published in the International Journal of Environmental Research and Public Health found that resistance training cuts inflammation in seniors with sarcopenia.

Researchers from the CDC’s National Center for Health Statistics examined differences in serious psychological distress in the past 30 days by work conditions, including shift work, variation in monthly earnings, perceived job insecurity, and work schedule flexibility. Data were extracted from the 2021 National Health Interview Survey.

Workers without paid sick leave (3.9%) were more likely to experience serious psychological distress than those with paid sick leave. Schedule flexibility also factored into a worker’s level of stress: Psychological distress was higher among those who had difficulty altering work schedules (4.2%) compared with those who had easily altered schedules (2.2%).

“These results suggest the role of work conditions, not just occupation and employment status, as social determinants of health,” wrote brief author Laryssa Mykyta, PhD.

A: Social isolation is a self-reported social determinant of health item coming to the Minimum Data Set this October. Section D responses range from “never” to “always,” with options if the resident is unwilling or unable to respond. 

Social isolation refers to lack of social contact with others. One-fourth of adults over 65 are socially isolated, according to NASEM. Loneliness is the feeling of being alone, regardless of social contact. 

The Centers for Disease Control and Prevention warns that social isolation and loneliness increase serious health risks, including risk of premature death. They also increase healthcare utilization. Chemical restraint, fall incidence, incontinence and feeding tubes increase residents’ risk for social isolation. 

When residents self-disclose social isolation, develop a care plan to mitigate or eliminate associated risks. Care planning for social isolation requires in-depth analysis of a resident’s experience, contributing factors and associated risks. Consider residents’ social networks, individual relationships’ strength and psychosocial functioning. 

Care planning should cover both a stay and after discharge. For residents lonely in the facility, invite them to activities they enjoy. If preferred activities aren’t available, try to incorporate them. For example, residents accustomed to a daily walk may enjoy a restorative walking program. When discharge planning, emphasize interventions such as visits from family, friends, clergy, or community groups.  

Because social isolation has such a significant impact on health risks, addressing it effectively positions residents for wellness both during and after their stays in a facility.

Please send your nursing-related questions to Amy Stewart at ltcnews@mcknights.com.

A full 69% of respondents said it was very important for SNFs, illustrating the growing urgency for long-term care providers to better manage the process of exchanging healthcare information with other providers. 

The biannual Interoperability and Engagement Research Report examined responses from more than 130 hospital and physician entities that refer patients for post-acute services and more than 300 post-acute care providers. Other key findings include the fact that 99% of referring entities said they’re more likely to send more referrals to SNFs that are more capable of receiving orders electronically. In addition, 79% of SNFs said they intend to invest in more advanced interoperability capabilities in the future, with nearly half of those planning to do so in the next 12 months.

Interoperability is in high demand partly because it enables the tracking of value-based care outcomes. According to respondents: 65% of referring entities report that greater than 25% of their revenue is now tied to value-based care arrangements, and 51% expect that percentage to increase over the next 12 to 18 months.

“As trends such as value-based reimbursement, care-at-home models, and clinical staffing shortages continue to impact the healthcare landscape, it is critical that PAC providers adopt the interoperable capabilities they need to gain efficient access to tomorrow’s referrals, deliver quality care to their patients, and improve outcomes,” said Nick Knowlton, vice president of Strategic Initiatives at healthcare technology firm ResMed. “This research initiative supports our long-standing mission to address unmet needs for advanced interoperability and engagement solutions across the post-acute care continuum and beyond.”

The survey was commissioned by technology provider Brightree and MatrixCare. 

A: A knowledgeable and organized LPN can be a valuable addition to your MDS department and fulfill many of the position’s responsibilities. But there are some requirements that only an RN can meet.

Federal regulations at §483.20(h)-(i) tell us that a registered nurse must conduct or coordinate each assessment with the appropriate participation of health professionals and sign and certify that the assessment is completed.

Nursing homes are left to determine who should participate in the assessment process, how the assessment process is completed, and how the assessment information is documented, while remaining in compliance with regulations and the instructions in the RAI manual. 

“Appropriate participation of health professionals” can involve multiple interdisciplinary team members, not limited to a social services designee, dietician, activity director, and, you guessed it,
LPNs/LVNs. 

Many facilities have successfully employed LPNs in lead MDS positions. In these cases, it’s up to the facility to determine how the RN will coordinate and complete the process. 

If you are lucky enough to have more than one nurse in the MDS department, only one needs to be an RN who will sign all MDS assessments as they are completed. Other facilities rely on varying RN nurse managers to meet this requirement, such as the director of nursing, assistant director of nursing, etc. 

Do make sure that this requirement is taken seriously. Civil monetary penalties will be imposed if anyone other than an RN signs the MDS as completed at Z0500. 

Please send your payment-related questions to Eleisha Wilkes at ltcnews@mcknights.com

A: Currently, federal regulations require nursing homes to provide licensed nursing services 24 hours a day, with a registered nurse on staff for at least eight consecutive hours a day, seven days a week. You are correct that several studies have found a positive association between RN hours and the overall quality of residents’ care. 

This has led groups to advocate for such a change in the rule. Particularly, advocates and lawmakers have proposed a new law requiring nursing homes to have an RN on staff 24 hours a day. 

Most people, inside and outside of the industry, can agree that the proposed law makes sense. Studies have shown a positive correlation between RN staffing levels and resident outcomes. 

For example, in one study, RN staffing levels were associated with fewer pressure ulcers, decreased infections, less improper and overuse of antipsychotics, and other notable care measures. 

Any legislation created to address this issue had better include an answer to the most critical question: Amid the current and sustained nursing shortage in this country, where will we find all these new registered nurses? 

The American Nurses Association estimates that more than one million new nurses need to join the workforce over the next few years to keep pace with those leaving the profession and the expected growth in population. Thus, the issue here is not just the unfunded mandate in the form of higher labor expenses for operators, but the very real problem of where we will find the one million women and men that are needed.

Please send your legal questions to Norris Cunningham at ltcnews@mcknights.com.