Savvy on the SOM’s Blog Roll

01.15.2019

Data Elements for Post Acute

So here is some information that apparently not a lot of providers know about.

There has been a collaboration between CMS and RAND Corporation to develop standardized data elements for Post Acute Care. The goal is to develop, implement and maintain standardized PAC patient assessment data.

This might be quite useful as you develop your own assessment data.

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Post-Acute-Care-Quality-Initiatives/Downloads/IMPACT-Act-SODF-March-28-2018.pdf

01.08.2019

Survey Entrance Conference

Are you preparing for a survey in the near future?

You know what paperwork will be requested immediately during the Entrance Conference. Will you find yourself scrambling to assemble it? What’s due in that first hour, four hours, and 24 hours?

No sweat! We can help!

Let’s go back to school and get a large 3 ring binder. Fill it with 28 tabbed dividers. Make divider labels that correspond to the number on the Entrance Conference Worksheet that require hard copy data. Are we having fun yet? Just like your high school Trapper Keeper.

Behind door (tab) #1 is your current actual census number. No hard copy data is needed, but keep it updated.

Entrance conference item #2 is a completed matrix on admissions in the last 30 days. This goes behind tab #2. Keep it updated. And so on and so forth.

Why would you do this?

CMS wants more surveys to start during off hours or on weekends. If the survey team shows up on Saturday or at 6 am, how will your staff give the team coordinator the paperwork required immediately?

A survey binder with all of the required paperwork will save someone a lot of unnecessary stress! Make sure your staff knows what the Survey Binder is and where it is kept.

Words of Wisdom

Items #2 and #18 – Completion of the Matrix (CMS 802) was updated 1/2018. Make sure you have the latest copy. The matrix forms should be updated weekly. It may need a tweak or two when the survey starts but nothing major. The latest matrix can be found at:

https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS802.pdf

We advise giving the matrix from item #18 (or at least offering it) to the survey coordinator during the Entrance Conference. The survey team will be grateful. We hope by having an up to date survey binder you and your staff will be ready for the first hour of your next survey.

No Sweat!

12.27.2018

Critical Element Pathways Part 1

During the new survey process, the survey team will utilize questions from several Critical Element Pathways when interviewing residents. The Critical Element Pathways were developed to assist surveyors in gathering information about the facility from the residents perspective and to standardize the questions asked of both residents and families.

The structure of the Critical Element Pathways encourages the use of multiple pathways and will form a network of linkages to potential deficiencies.

The staff at SAVVY on the SOM is recommending that the questions on these Critical Element Pathways be reviewed by the Administrative and clinical staff. Perhaps more importantly, these questions should be used to solicit input from residents and families prior to your next survey.

If residents or families have voiced dissatisfaction with aspects of care or the services at the facility, these should be resolved before your survey.

Care Planning Pathway

Ask your residents –

How did the facility involve you in your care plan and goals?

What are your goals for care? Is the facility helping you to meet your goals? How?

Ask your new admits – Did you receive a copy of your baseline care plan? Did you understand it?

For Pain Management Pathway

Ask your residents –

How were you involved in developing pain management strategies?

What treatment options (pharmacological and non-pharmacological) have been discussed with you? Were possible outcomes of different options discussed with you?

Sufficient and Competent Staff Pathway

Ask your residents –

Do you feel there is enough staff to care for you and answer your call light promptly? Are there any problems at shift change or on the weekends?

Are you able to wake, rise, eat at times you prefer?

Do you think the nursing staff are knowledgeable when caring for you?

Have you had to return to the hospital for any reason?

Behavioral Emotional Status Pathway

How are the resident’s needs being met through a person centered care approach? Can you give examples?

Urinary Catheter Pathway

Why is a urinary catheter being used? How long has the urinary catheter been in place?

Ask your resident –

Were the risks and benefits of the catheter discussed with you?

Do you have any pain or discomfort from the catheter?

Hearing and or Vision Pathway

Ask your resident –

Do you need or have you requested device(s) to assist with hearing or communication? How has the facility helped you?

If you have refused devices, what alternatives have been discussed with you??

Dental Pathway

Ask your residents –

Do you have any dental concerns which have not been addressed by the facility staff?

Are you experiencing any pain or difficulty eating because of a dental problem?

Have you had any missing or damaged partials or dentures? If so, did the facility make a referral within 3 business days?

How did the facility ensure you would be able to continue to eat and drink while waiting for dental services?

Dialysis Pathway

Ask your residents –

If you refuse a fluid and or dietary restriction, has the staff attempted to find alternatives and explained the potential consequences?

Nutrition/Diet Pathway

Ask your residents –

How does the staff involve you in decisions about your diet, food preferences, and where to eat?

Does the staff give you the correct diet, snacks, and supplements, and honor your preferences?

Therapy

Ask your residents –

How were you informed about your need for therapy? Were alternatives discussed with you?

Did anyone talk to you about possible consequences if you refused therapy?

Are the services helping you to improve? How?

If you have assistive devices, were you shown how to use the device correctly?

This is just a sampling of the types of questions contained in the Critical Element Pathways. Perhaps you’ve gathered that you should ASK YOUR RESIDENTS. All the Critical Element Pathways were updated 8/3/18, and are available at:

https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/GuidanceforLawsAndRegulations/Nursing-Homes.html

12.11.2018

The Cost of Pressure Injury

According to the Agency for Healthcare Research & Quality (AHRQ), pressure ulcers cost the US healthcare system an estimated $9.1-$11.6 billion annually.

According to the National Database of Nursing Quality Indicators, the average cost of a pressure injury is $38,700.00!

Much of the following information was received by subscribers of SAVVY on the SOM in Volumes 3 and 4. It bears repeating because of recent survey deficiencies for the development and worsening of pressure injuries.

Remember that prior to a facility survey, the survey team will review the facility’s history including the deficiencies from the last survey, the facility’s CASPER report, and any complaints with deficiencies. The Resident Level Report will identify any residents with a new or worsening pressure injury. These residents will be targeted for interview and review during the initial tour rounds.

Since pressure injury is such a high cost item and will always be a focus area during surveys, Administration and the QAA committee must make an ongoing commitment to monitor and analyze pressure injury outcome measures.

Do you have a problem? Analyze what you’ve got!

The Quality Assurance Committee can begin by reviewing the Facility Characteristic Report and the Facility Quality Measure/Indicator Report to understand how your facility compares to other facilities in your state. Do you have a higher incidence of pressure injuries? How many of these pressure injuries were present on admit vs pressure injuries which developed after admission? If a pressure injury developed after admission, did the facility do a root cause analysis to determine why the pressure ulcer developed? Was the root cause analysis completed by a multidisciplinary team? How did the care plan change after the development of the facility acquired pressure injury? Can you prove that the care changed? If the facility received a deficiency at F 686 during your last survey, was your Plan of Correction (POC) implemented? Was your Plan of Correction effective? How do you know your POC was effective?

Note: During the Quality Assurance interview, the facility Administrator will be asked for proof that the POC was implemented and was effective.

Chart reviews may or may not tell you if the POC was implemented but direct observation of care may give you the information you need. Correlate the observations with the actions found in the resident care plan and assess the care plan. Is it specific to this resident and the identified risk factors or is the care plan canned text?

From a surveyor’s perspective, facilities receive deficiencies at F686 due to a lack of staff knowledge about preventing pressure injuries, understanding severity/staging of pressure injuries, lack of ongoing assessments, care plans which are not resident specific, care plans which do not address risk factors, care plans which are not consistently implemented, lack of root cause analysis of pressure injuries, and lack of a multidisciplinary input into care planning.

These are process problems and process problems belong to the Administrative team and the Quality Assurance Committee.

A word of caution

While implementation of the facility QAPI plan is not required until Phase 3 – November 28, 2019 – the facility must be prepared to present its QAPI Plan to the State Survey Agency beginning November 28, 2018 (see F865).

11.27.2018

Person Centered Care Plan & the Resident with Dementia

The initial assessment for the newly admitted resident with a diagnosis of dementia will contain many of the same elements as any other assessment but for the care plan to be an effective tool, the nurse will need additional time and assessment skills.

The data gathered will be a more personal history of who this person was in the past, who this person is now and what happened in between.

The goal of any care plan is to assist caregivers at all levels to understand who this resident is and how to approach and provide care to this person. If the resident is non-verbal then information may be obtained from a family member or previous caregivers.

The care plan for the resident with Dementia should include as much information as possible about the following areas:

  • Social functioning

  • Cognitive Ability

  • Family Structure

  • Emotions

  • High risk/safety issues

  • Sleep/wake

  • Showering/bathing

  • Grooming

  • Dressing

  • Toileting needs

  • Meal Times/food

As each discipline gathers data, the goals for this resident should focus on ways to help this person find meaning, comfort, pleasure, security and self worth. Interventions should focus on meaningful activities which are specific to this resident.

This is where involvement of the family may be vital. Knowing what activities gave this resident pleasure in the past may be the key to meaningful activities now. Most activities can be adapted to the resident’s current abilities from listening to concerts, watching a ballet or listening to talking books. Finding ways to keep a resident engaged in meaningful activities prevents social isolation and may prevent behavioral problems. Volume 15 of SAVVY on the SOM covers person centered care in depth for more information.

11.13.2018

Cultural Competence 101

Cultural competence can be defined as the willingness, knowledge and the ability to meet the cultural, social and language needs of residents and their families.

Cultural competence is an understanding of human behavior shaped by race, socioeconomic factors, ability (physical, mental, emotional), ethnicity, language, gender, sexual orientation, values, and beliefs. A culturally competent provider must have the ability to understand and integrate these factors into the facility culture and the daily delivery of health care.

How do we begin to change our facility culture?

Review the Annual Facility Assessment AND the Community Health Needs Assessment done for your county or nearest geographic area. What do these documents tell you about the cultural make up of your community and service area? What ethnic groups or nationalities are present? What religions,churches,temples, or mosques are present? What are the demographics of your service area? What are the needs of your current population now and anticipated in the future?

If the community is changing, how will you embrace the change and prepare your staff? Some strategy suggestions:

  • Visit different ethnic cultural centers in your community. Speak to the leaders of these centers and ask for their help in training your staff on the important aspects of their culture.
  • Visit the non-traditional churches, temples, and mosques in your community. Again, ask for their help in teaching your staff about their religious beliefs and practices. Be open to offering more diverse religious services. Include traditional healers.
  • Welcome visitors from both different cultural centers and religious organizations.
  • Include cultural norms and values when developing a resident centered care plan.
  • Locate other health providers and clinics within your community which provide care to specific ethnic groups. These may be the places which will be providing care to your residents after discharge. If so, open communication and good working relationships can ensure a smooth discharge plan and may possibly prevent hospital re-admissions.
  • Provide training to all staff from receptionists to clinical and dietary staff. Incorporate cultural attitudes and values into job description and annual evaluations.
  • Provide interpreter services or a language line. Use language cards to enhance communication with non-English speaking residents.
  • Recruit minority staff.
  • Include family and extended family members in decision making and discharge planning.

Cultural competence is not an isolated aspect of health care delivery but it can be a huge factor in resident and family satisfaction.

11.06.2018

Guidelines for Determining Immediate Jeopardy

Appendix Q standardizes the definition of Immediate Jeopardy and gives providers insights into how and when surveyors will make a determination of Immediate Jeopardy as follows:

A situation in which the provider’s noncompliance with one or more requirements of participation has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident.”

  • Only ONE individual needs to be at risk.
  • Serious harm, injury, or impairment does not have to have occurred.
  • High risk for serious harm, injury, or impairment in the future is enough to make a finding of immediate jeopardy.
  • Because serious physical or psychological harm can result from abuse and/or neglect, residents must not be subjected to abuse/neglect by anyone – staff, visitors, family or another resident.
  • Any determination of abuse or neglect is always immediate jeopardy.

Surveyor Investigation

The risk may have occurred in the past, may be occurring now, or may most likely occur in the future if a given situation is not immediately corrected.

The investigation will focus on:

  • Did the facility create or know that a situation was occurring which had the potential to cause serious injury, harm, impairment or death?
  • Did the facility have the means to implement preventive or corrective measures?

Some examples of surveyor observations which will initiate further investigation and a possible finding of Immediate Jeopardy are as follows:

  1. Unexplained serious injuries which have not been investigated. All fractures or dislocations – even if witnessed – should be investigated as possible abuse or neglect. Multiple episodes of falls with injuries are suspicious.
  1. Bruises around the breast or genital area, injuries such as black eyes, rope marks, cigarette burns, or any unexplained bruising should raise questions about abuse. Injuries such as these must be investigated by the facility. Prudent judgment would indicate these injuries should be reported to the surveying office as possible abuse.
  2. Failure to monitor physical or psychological aggressive behaviors by any person including other residents, staff, visitors or family. The facilities obligation is to protect residents in their care. Aggressive behavior from another resident or a family member is a form of abuse and cannot be tolerated.
  1. Unsafe dietary practices with the potential for food borne illnesses. Isolated observations of the dietary staff not using appropriate infection control practices may not rise to the level of Immediate Jeopardy but ongoing or widespread inappropriate actions have the potential to rise to the level of Immediate Jeopardy.
  2. Widespread lack of knowledge/competency by staff. Surveyor observations of actions or behaviors which do not meet the professional standards of practice accompanied by a bad clinical outcome may lead to a citation of Immediate Jeopardy.

These are a few of the “triggers” which will cause a survey team to begin investigating for possible Immediate Jeopardy. It is important to remember that the survey team will thoroughly investigate any situation with the potential for immediate jeopardy. Before a final determination of Immediate Jeopardy, the surveyor agency office will be consulted and the team’s findings reviewed.

As a provider, it is important to understand Appendix Q to avoid an Immediate Jeopardy situation.

The CMS site for Appendix Q has many more “triggers” for your review.

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_q_immedjeopardy.pdf

10.29.2018

Value Based Purchasing and Hospital Readmission

In 2014 a healthcare law, Protecting Access to Medicare Act (PAMA), started the SNF Value Based Purchasing Program.

Each year, CMS publishes a regulation that outlines what is required for the SNF VBP program. The most recent regulation uses the Skilled Nursing Facility 30-Day All-Cause Readmission Measure (SNFRM) to determine a 2% incentive payment or a 2% payment reduction based on the outcomes of the measure. The intent of the SNFRM is to encourage SNF providers to monitor and reduce hospital readmission, thereby reducing costs and improving the quality of care.

We are sure every LTC provider is concerned about the possibility of losing 2% of their reimbursement based on hospital revisits under the Value Based Purchasing program. Our research team came across two very interesting programs which offer some innovative practices to reduce 30 day hospital readmission.

The first is from a Veteran’s facility in Utah. The facility has engaged physicians and home health providers in working together to successfully reduce hospital recidivism.

https://skillednursingnews.com/2018/10/secrets-success-top-snf-country-rehospitalization-rate/

The second article briefly shares the results of a grant from CMS to the University of Missouri’s Sinclair School of Nursing to place APRNs in SNFs to reduce hospital readmission. The Sinclair School of Nursing has done some awesome research and this particular program has had some amazing results.

https://skillednursingnews.com/2017/08/certain-nurses-can-lower-hospital-readmission-rates-snfs/

10.23.2018

TIPS FOR THE MEDICATION PASS

During every certification survey, the surveyors will observe at least 25 medications administered to residents. The surveyors will want to see as many different types of administrations (eye, ear, nose, inhalations, GT, oral, injection) as possible.

A BIG warning!

The facility (hopefully!) has a “no interrupt” policy for the nurse while doing a medication pass. In our collective years as surveyors it was extremely rare to observe nurses who absolutely would not allow anyone to talk to them when they were passing medications. Staff could place a note on their notepad but could not speak to them. This is not to say that these medication nurses were not mindful of messages but they simply would not allow themselves to be distracted during a medication pour or administration.

When one does a literature review on medication errors, the conclusion is almost always the same. Medication errors are one of the most preventable errors made in healthcare facilities and one that has the potential for serious consequences for residents.

If your facility has not done so already, develop a “no interrupt” policy for your medication nurses – no telephone, no communication headgear, no pages, and no interruptions – period!

What are surveyors observing?

  • Is the medication cart clean and organized?
  • Has the medication nurse stocked the cart with needed supplies?
  • Are juices, sauces, puddings chilled if needed?
  • Does the medication nurse coordinate the medication pass with the CNA to make sure incontinent residents are clean?
  • Does the medication nurse coordinate the medication pass with the treatment nurse for dressing changes?
  • Are BPs taken before administering an antihypertensive? Are postural BPs taken if the resident is ambulatory?
  • Does the medication nurse enter the room prior to the administration to inform the resident of the impending medication pass and clear a space on the over bed table for the medication tray?
  • When pouring medications does the nurse check for the expiration date(s)?
  • Are bottles of liquid medications clean?
  • Are the labels on each medication clean and clear? Does the label match the instructions on the MAR? Are the medications poured as ordered?
  • Does the nurse show professional standards of practice, competence, and infection control measures during the medication pour and administration?
  • Does the medication nurse interact with each resident in a manner which shows respect and the principles of resident focused care?

During the observation:

The surveyor will ask the medication nurse to pass her the medication after is has been poured. The surveyor will check the expiration date and write down the label instructions. At the end of the pour, the surveyor may ask the nurse to count the pills and compare the number to her count of what should be administered.

Quick Tips:

Infection control practices are imperative. Hand washing and appropriate use of gel is a must.

Nurses must know what medications can’t be crushed, what patch sites must be rotated and how to rotate, and how analgesic patches are to be discarded and where to discard.

If 30 ml of a liquid medication is ordered, use the small plastic medicine cup to measure but then put the 30 ml in a 4 or 8 ounce cup. This prevents the unstable 30 ml cup from falling over, especially if the nurse’s hands are shaking.

Nurses should know how to prepare a resident for eye, nasal, or inhaled medications. Eye areas should be gently cleansed to remove debris. Many eye medications have a wait time for multiple drops or if different eye medications are administered. The resident should blow their nose before receiving a nasal spray medication. Residents who will use an inhaler should be encouraged to clear their throat before using the inhaler. The nurse should make sure the resident knows how to use the inhaler and follows the proper techniques including rinsing their mouth afterwards.

GT medications must be given individually and never mixed. If a resident with a GT indicates any discomfort during the administration of medications or flails their arms, the administration should stop immediately. It is never OK to cause pain during the administration of medication. The cause of the discomfort must be found and treated. To continue with the medication pass when a resident is in pain or agitated would be an example of abuse.

Volume 21 of SAVVY on the SOM will begin our series on Medication Safety and will include a much more extensive presentation on the regulatory requirements and implementation strategies. Consider a subscription and stay on top!

10.09.2018

Animals in Skilled Nursing Facilities

We were recently asked about policies and procedures for animals in health care facilities. There are no specific regulations in the SOM related to a facility having a resident pet. We think this is one of those common sense safety issues. Some states do have state regulations pertaining to animals in healthcare settings. Remember you are required to follow the strictest regulations.

To help you do some research, we have included a bibliography with this blog (similar to the bibliographies we include with each issue of SAVVY on the SOM.) One of the articles in the bibliography does go through the various state regulations pertaining to animals in healthcare facilities and the state requirements. It is worth reviewing!

Other areas to consider when thinking about “adopting” a facility pet would include:

  1. What type of pet are you considering? Your policies and procedures should be specific to the type of pet.
  2. What are the possible dangers anticipated with this type of pet. Type and variety do matter when it comes to temperament!
  3. Obtaining a veterinary clearance. Will follow up exams be bi-annual or annual?
  4. What type of “bugs” and bacteria are most common with this particular animal? How will these bugs be controlled or eliminated? Can these bugs or bacteria be transmitted to humans?
  5. How will you keep your residents safe from harm? For example how will you prevent/treat fleas? How will you protect residents from flea bites?
  6. How will you “toilet” this animal? If this animal lives in a cage, who will clean the cage? If the animal is a dog or cat, how will toileting be handled and by whom?
  7. Who will feed and water the animal and when?
  8. Where will the animal sleep?
  9. Who and how often will the animal be bathed?
  1. What happens if residents are allergic to pet dander?
  2. What happens if a resident does not want to be near the facility pet?
  3. What is your liability if a resident or a visitor get bitten by the facility pet?
  1. How will you ensure the pet is not permitted in the kitchen, the medication room, the supply room, an isolation room, or in a room during a dressing procedure?

This is not an all-encompassing list but these are areas to consider.

Certainly pets have been shown to have a positive impact on residents and many residents would enjoy the presence of a pet.

As always, proceed with caution.

  1. Animals in Healthcare Facilities: Recommendations to Minimize Potential Risks (SHEA)

This article, although somewhat long, summarizes the policies from various healthcare institutions and gives recommendations.

  1. Medscape slide show which is sponsored by SHEA. Good information without excessive verbiage.
  1. Long Island State Veterans Home

Policy on service animals. Offers good suggestions.

  1. Quality of Life – Pets and animal therapy.

This article reviews regulations by state.

10.2.2018

Person Centered Care

We eat fast food. Fast food is not a healthy choice.

The posted speed limit on the freeway is 70 miles per hour. Many drivers exceed the speed limit. This is not a safe decision.

The annual flu shot is encouraged. We are warned each year about the flu season. Many people ignore the warnings.

These are a very few of the decisions we make every day. We all have the freedom to make poor decisions. I, for one, do not want anyone to take away my freedom to make a poor decision. Now apply this freedom to make a poor decision to residents in Skilled Nursing Facilities. The angst is enormous!

While we do realize Resident Focused Care is a major culture change and will need to be implemented carefully, thoughtfully, and over time, some of the questions we have received seemed to be focused more on legal liability rather than the resident’s quality of life.

A few examples:

A resident with diabetes refuses to follow the diet prescribed by her physician. Her family brings in fast food. Her blood sugars are over 200. Can the facility ban the family from bringing in fast food?

A resident with congestive heart failure was placed on a 2000 mg sodium diet. The resident sneaks high sodium snacks like potato chips and corn nuts. How can we stop this behavior?

A staff physician does not allow his residents to have any sodas and writes this order in every chart. One of his residents wants 12 to 15 sodas a day. The resident insists that it is her right to have these sodas. We feel like we are stuck in the middle. What can we do?

SAVVY on the SOM replies:

Let’s try a simpler analogy. If a resident stated she/he wanted to take a double dose of Levothyroxine because this would help them lose weight, what would you do? Immediately and without question you realize the potential for harm, right? It’s pretty clear cut. You don’t have to be an attorney to know that the principles of common sense and professional responsibility would apply.

BUT you, as the medical professional, have a professional responsibility to listen, ask questions to understand the resident’s point of view, to provide education, and to document your interventions. You are not obligated to provide a service which you know is not a standard of practice and which could harm a resident.

You might respond to this resident with “tell me more about what you have heard/read,” and after listening, do further research, correct any facts you know to be false, discuss with the medical director or the resident’s PCP – and – document, document, document!

While real life situations are not so black and white, you will have many roles to play. Resident Focused Care will require careful navigation of these roles – educator, communicator, arbitrator, and counselor just to name a few.

When a resident wants to not follow a prescribed diet or eat salty food or drink a ton of soda – they have that right.

You have an obligation to listen, to educate, and try to negotiate a healthier choice.

For the diabetic, what is it they don’t like about their diet? Could the diet be liberalized? Would the resident be willing to maintain a diary of their blood sugars so they are in charge of documenting what they eat and what happens to their blood sugars? Can you educate the family on the results of all that fast food? Would the family be willing to help maintain the blood sugar/food diary? How often is the resident eating fast food? If the fast food is three times a week, would the resident be willing to cut down to once a week? Could the facility prepare a turkey burger and air fried potatoes one time a week in place of the fast food meal?

For the resident with CHF are they eating salty snacks because they like the salt or the crunch or because they just want to snack and this is what they had a home? Are they symptomatic (ankle swelling, rales, increased BP, etc.)? Are they OK with the rest of the diet? Would they be willing to try some substitutes for crunchy and salty? Would they be willing to try popcorn with buttery spray and butter buds or a little garlic powder; or warmed rice Chex with butter buds or broken Melba toast with unsalted peanuts and Chex cereals?

For the soda addict, you may have to negotiate with the physician first. Would she or he be willing to look at a more reasonable approach like maybe one soda with lunch and dinner and one soda in the afternoon or evening? Then you may need to negotiate with the resident on what the facility can accommodate. If the facility can only supply three sodas a day, would the resident be willing to “stretch” the sodas out by mixing ½ a soda with fruit juice – i.e. ½ orange soda with ½ orange juice or ½ raspberry soda with ½ cranberry juice or ½ vanilla soda with ½ club soda and sugar free vanilla syrup?

We do not think that Resident Focused Care obligates a facility to supply a resident with foods or drinks which have the potential to harm a resident. A facility has no obligation to supply a diabetic resident with fast food which will elevate his blood sugar or supply a cardiac resident with salty snacks which may precipitate CHF or supply a resident with 12 sodas a day. A reasonableness factor applies in all of these cases.

HOWEVER, a facility does have an obligation to listen to a resident’s need/desires, to clarify and understand, to educate, to offer alternatives, to attempt compromise, and to document, document and document.

Is this easy? NO!

Is this necessary? YES!

And one last bit of advice – never, ever, refer to this resident a non-compliant!

Archives

09.25.2018 – Baseline Care Plan

09.18.2018 – Hospice and the SNF – Deficiencies

09.11.2018 – Hospice and the SNF

08.28.2018 – Staff Competency & the Patient Driven Payment Model

08.21.2018 – Food and Nutrition in LTC – Part II

08.14.2018 – The SNF Readmission Reduction Program

08.07.2018 – Sexual Harassment in LTC

07.31.2018 – Death with Dignity Laws and LTC

07.24.2018 – The New Pharmacy F-Tags

07.17.2018 – Summer Sizzle

07.12.2018 – Food and Nutrition in LTC 

07.05.2018 – Abuse in LTC – Part 2 

06.26.2018 –  Where in the world shall we live? 

06.19.2018 – Abuse in LTC– Part 1

06.12.2018 – On Smoking in LTC 

06.05.2018 – Let’s Talk About Teeth 

05.29.2018 – Leadership

05.22.2018 – Are Baseline Care Plans a Big Deal?

05.15.2018 – LGBTQ Rights and Long Term Care 

05.08.2018 – Cannabis in LTC – Part 2

05.01-2018 – Cannabis

04.24.18 – Cultural Competence

04.17.18 – Active Shooter

04.10.18 – LTC Water Requirements in a Disaster

04.03.18 – Resident Trust Accounts – Part 4

03.27.18 – New Five Star Quality Rating System

03.20.18 – On Falls – Again

03.13.18 – A Word About Money – Resident Trust Accounts Pt.3

03.06.18 – A Word About Money – Resident Trust Accounts Pt.2

02.27.18 – A Word About Money – Resident Trust Accounts

02.20.18 – Quality Improvement Culture

02.13.18 – Are You 5 Star Quality?

02.06.18 – Phase 2 Implementation

01.30.18 – F 838 SNF Administrative Roles

01.23.18 – Flu Season Prep

01.16.18 – LTC Lacks Geriatric Training

01.09.18 – QA + PI

01.02.18 – Revised CMS Survey Requirements

12.19.17 – Epic Tool for LTC Survey Preparation

12.12.17 – Smoking Regulations and LTC

12.05.17 – LTC – the elephant in the room?

11.28.17 – Abuse reporting in LTC

11.21.17 – Emergency Preparedness and LTC

11.14.17 – Abuse Reporting in LTC

11.07.17 – Finding the Base of Baseline Care Plans

10.31.17 – Fight the Flu in LTC

10.24.17 – LTC needs a new image – Part II

10.17.17 – Restraint with Restraints – Alternatives

10.10.17 – Show Restraint with (Chemical) Restraints

10.03.17 – Show Restraint with Restraints

09.26.17 – LTC needs a new image…

09.19.17 – SNF’s, Surveys and Pressure Injury

09.12.17 – F tag changes – Infection Control

09.05.17 – Well-Being and the SNF

08.29.17 – Infection Protection in SNFs

08.22.17 – Don’t Panic – Be Savvy

08.15.17 – Newest Tool for Medicare Compliance

08.08.17- Tools for Cultural Competence in SNFs

08.01.17 – Never Non-Compliant

07.25.17 – New Regs from CMS – Phase 2

07.18.17 – Phase II & the SNF DON

07.11.17 – What is Clinical Competency?

07.06.17 – The Terrible, No Good, Rising Cost of Pressure Injury Part III

06.27.17 – Are you SAVVY on the SOM?

06.20.17 – The Terrible, No Good, Rising Cost of Pressure Injury Part II

06.13.17 – Phase II – Facility Annual Assessment

06.06.17 – Restraint or Enabler?

05.30.17 – Quality of Life Interviews and YOU

05.23.17 – The terrible, no good, rising cost of Pressure Injury

05.16.17 – Let’s Talk about Eggs

05.09.17 – Don’t Slip on Fall Prevention

05.02.17 – Hospice in Skilled Nursing

04.25.17 – Let’s Talk About McGeer’s

04.18.17 – Survey Ready – Initial Tour Rounds

04.11.17 – “Person Centered Care”

04.04.17 – On Antibiotic Stewardship

03.28.17 – Kitchen Catastrophe?

03.21.17 – Suffer from Survey Anxiety?

03.14.17 – Activities Program 2.0

03.07.17 – Worried about Functional Outcomes?

02.28.17 – on referrals

02.16.17 – Care Plan Woes?

01.17.17 – Brand New Day