-
Thursday January 5, 2012
Influenza can spread quickly and have serious consequences in
long-term care facilities, putting residents - especially those
with certain medical conditions at greater risk of developing
complications like pneumonia and bronchitis. The flu also can make
chronic health problems worse and may result in hospitalization and
sometimes even death.
The January 6, 2012 Morbidity and Mortality Weekly Report
includes a report that highlights the importance of having and
following an influenza outbreak management strategy.
CDC has posted consolidated influenza outbreak management
guidance for long-term care facilities at: www.cdc.gov/flu/professionals/infectioncontrol/ltc-facility-guidance.htm
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Wednesday January 4, 2012
Federal Requirements for the Independent Informal
Dispute Resolution Process
New regulations have been added at 42 CFR, Sections 488.331 and
488.431 as required under section 6111 of the Patient Protection
and Affordable Care Act of 2010 enacted on March 23, 2010. This
memorandum provides interim advanced guidance regarding the Federal
requirements for the Independent IDR Process for nursing homes.
The Centers for Medicare & Medicaid Services (CMS) is in the
process of updating the SOM to reflect the new regulations found at
42 CFR Sections 488.331 and 488.431. An advance copy of the interim
guidance is attached to the memorandum.
IDR S&C Letter Dec 2011
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Wednesday January 4, 2012
CMS Issues New Guidance for 2012 Medicare S&C
Budget
The Centers for Medicare and Medicaid services (CMS) issued a
new S&C memorandum on December 9, 2011 related to the Survey
and Certification Budget for Physical Year 2012. The memorandum
states that CMS is exploring methods to increase the focus on
certain high priority areas. To make possible such increased focus
and to accommodate the budget constraints, they are examining ways
to reduce surveyor time in areas of lower risk. Particular areas in
which they seek to increase the focus include:
- Poorly Performing Nursing Homes
- Inappropriate Anti-Psychotic Use
- Avoidable Falls
The effective date of this material is January 1, 2012.
For more details see attached memorandum.
FY 2012
Medicare S&C Budget
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Wednesday January 4, 2012
Smoking Safety in Long Term Care
The Centers for Medicare and Medicaid Services (CMS) issued a
Survey & Certification (S&C) Memorandum November 10, 2011
reminding both surveyors and facilities of the importance of
smoking safety for residents who smoke. The S&C memo reviews
some of the information contained in the Surveyor Guidance for F323
- Accidents & Supervision.
Smoking Safety in Long Term Care
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Wednesday January 4, 2012
Pioneer Network Announces New Dining Practices
Standards
The Pioneer Network announced that its Food and Dining Clinical
Standards Task Force: A Rothschild Regulatory Task Force has
finalized new Dining Practice Standards agreed to by twelve
national clinical standard-setting associations. These nationally
agreed upon new food and dining standards of practice support
individualized care and self-directed living versus traditional
diagnosis-focused treatment for people living in nursing home. The
New Dining Practice Standards document reflects evidence-based
research available to-date as well as current thinking.
The Pioneer Network stated that the importance of these new
agreed upon clinical standards cannot be overstated as food and
dining are an integral part of individualized care and
self-directed living for people living in nursing homes.
Pioneer Network plans to submit the new Dining Practice
Standards to CMS, FDA,
CDC and the long-term care community at
large. It is anticipated that CMS
will refer to these new agreed-upon standards of practice within
long term care interpretive guidance where they fit as
CMS usually refers to the current standards of
practice set by the clinicians who work within the long term care
field. It is the goal of the Task Force that surveyors, clinicians
and interdisciplinary team members will put these new standards
into practice in order to continue their efforts to improve quality
of life for those living in nursing homes across the country.
New
Dining Practice Standards 8-26-11
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Wednesday January 4, 2012
OSHA to Focus on
Nursing Home
The Occupational Safety and
Health Administration will soon launch the National Emphasis
Program on Nursing Homes and
Residential Care Facilities. This is in response to what
OSHA sees as higher than
average incidents of occupational injuries and illnesses among
health care support
workers. Through this initiative, they
will increase inspections of these facilities, focusing on back
injuries from resident handling or lifting patients; exposure to bloodborne pathogens and
other infectious diseases; workplace violence; and slips, trips and
falls.
See OSHA Press Release 2011 for
more details.
OSHA
Publishes New and Updated Materials on Worker Safety and
Health
The Occupational Safety and Health
Administration (OSHA) recently published new and updated educational brochures on a
number of topics including workers' rights, employers' rights following an OSHA inspection,
as well as how to protect workers from hazards in the construction, general and maritime
industries. OSHA's Worker' Rights booklet describes
the rights to which
workers are legally entitled under the Occupational Safety and
Health Act. The booklet,
Employer Rights and Responsibilities Following an OSHA
Inspection, reviews what happens after an inspection and is
provided to employers during an OSHA inspection. The agency also recently published an
updated Construction Industry Digest, and a new Small
Entity Compliance Guide for Respiratory
Protection Standard, Laboratory Safety Guidance, a
series of new QuickCards
and new publications to help protect construction, general industry
and shipyard workers.
Please call 1-800-321-OSHA or (202) 693-1999 to order copies or
visit OSHA's
Publications page: http://www.osha.gov/pls/publications/publication.AthruZ?pType=AthruZ)
to order online.
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Monday February 27, 2012
Once an outbreak has been identified, it is important the
facility take the appropriate steps to contain
it. State, local and county health departments
offer guidance and regulations regarding responding to and
reporting outbreaks. This information is often
received in advance of an outbreak and included in the infection
prevention and control program. Plans for containing outbreaks
usually include efforts to prevent further transmission of the
infection while considering the need of all residents and
staff.
We suggest that you review the Regulations in Assisted Living
and Specialty Care Assisted Livings to ensure Regulatory
Compliance. This information can be found in: Alabama Assisted
Living Rules and Regulations 420-5-4-.05 Records and
Reports andAlabama Specialty Care Assisted Living Rules
and Regulations 420-5-20-.05 Records and
Reports.
It is important that all infection prevention and control
practice reflect current Centers for Disease
Control guidelines.
Each facility should refer to their specificState:
- Rules and Regulations; and
- State and local health departments for reporting guidelines and
recommendations.
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Monday February 27, 2012
Due to the recent reported cases of the Norovirus in nursing
homes and assisted living facilities it is important that we
remember what the facility's role and responsibility is regarding
infection control.
Under the guidance for Surveyors in the State Operations Manual,
F-441Infection Control, states; Recognizing and
Containing Outbreaks An outbreak is typically one or more of the
following:
- One case of an infection that is highly communicable;
- Trends that are 10% higher than the historical rate of
infection for the facility that may reflect an outbreak or seasonal
variation and therefore warrant further investigation; or
- Occurrence of three or more cases of the same infection over a
specified length of time on the same unit or other defined
areas.
Once an outbreak has been identified, it is important the
facility take the appropriate steps to contain it. State
health departments offer guidance and regulations regarding
responding to and reporting outbreaks. This information is
often received in advance of an outbreak and included in the
infection prevention and control program. Plans for containing
outbreaks usually include efforts to prevent further transmission
of the infection while considering the need of all residents and
staff.
It is important that all infection prevention and control
practice reflect current Centers for Disease
Controlguidelines.
Component of an infection Prevention and Control Program
- Policies and procedures
- Infection Preventionist
- Surveillance( process and outcome)
- Documentation
- Monitoring
- Data Analysis
- Communicable Disease Reporting
- Education
- Antibiotic Review
Facilities should review the complete guidance under CFR §483.65
Infection Control F441 for more details.
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Tuesday February 21, 2012
As part of President Obama's commitment to reducing regulatory
burden, Health and Human Services Secretary Kathleen G. Sebelius
announced that HHS will initiate a process to postpone the date by
which certain health care entities have to comply with
International Classification of Diseases, 10th Edition
diagnosis and procedure codes (ICD-10).
The final rule adopting ICD-10 as a standard was published in
January 2009 and set a compliance date of October 1, 2013 - a delay
of two years from the compliance date initially specified in the
2008 proposed rule. HHS will announce a new compliance date
moving forward.
"ICD-10 codes are important to many positive improvements in our
health care system," said HHS Secretary Kathleen Sebelius.
"We have heard from many in the provider community who have
concerns about the administrative burdens they face in the years
ahead. We are committing to work with the provider community
to reexamine the pace at which HHS and the nation implement these
important improvements to our health care system."
ICD-10 codes provide more robust and specific data that will
help improve patient care and enable the exchange of our health
care data with that of the rest of the world that has long been
using ICD-10. Entities covered under the Health Insurance
Portability and Accountability Act of 1996 (HIPAA) will be required
to use the ICD-10 diagnostic and procedure codes.
All HHS press releases, fact sheets and other press materials
are available at: http://www.hhs.gov/news.
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Tuesday February 21, 2012
Healthcare facilities, including nursing homes and hospitals,
are the most commonly reported settings for norovirus outbreaks in
the United States. The virus can be introduced into healthcare
facilities by infected patients/residents--who may or may not be
showing symptoms--or by staff, visitors, or contaminated food
products. Outbreaks in these settings can be quite long-sometimes
lasting months-and illness can be more severe, occasionally even
fatal, in hospitalized or nursing home patients than for otherwise
healthy persons.
Noroviruses are responsible for about half of all reported
outbreaks of gastroenteritis (vomiting, diarrhea, and stomach
cramping caused by inflammation of the stomach and intestines).
While the vast majority of norovirus illnesses are not part of a
recognized cluster, outbreaks provide important information on how
the virus is spread and, therefore, how best to prevent
infection. Norovirus outbreaks occur throughout the year, but
over 80% of them occur during November-April. In addition,
norovirus outbreaks tend to increase periodically when new strains
of the virus appear. The virus can be spread through food, water,
by touching things that have the virus on them, as well as directly
from person to person. There is no long-lasting immunity to
norovirus; thus, outbreaks can affect people of all ages and in a
variety of settings
Due to the recently reported outbreaks of the norovirus in Long
Term Care and Assisted Living facilities we have attached several
CDC norovirus related documents.
For more information we encourage you to visit the CDC web
site at: http://www.cdc.gov/ncidod/dvrd/revb/gastro/norovirus.htm
Norovirus-Guideline for Healthcare Settings-2011
Norovirus Worksheet
Norovirus Poster
Norovirus Comm Framework
Norovirus Case Fact Sheet
NoroVirus-Management of Outbreaks in Healthcare Settings
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Wednesday February 15, 2012
Healthcare providers could get some regulatory deadline relief
soon. The acting head of the Centers for Medicare and Medicaid
Services said today the agency is considering extending its
timeline for ICD-10 code conversion compliance.
Under current ICD-10 rules, healthcare providers, payers, and
others have until Oct. 1, 2013 to switch over their claims,
billing, and other systems from current ICD-9 to ICD-10 codes for
medical diagnosis and inpatient procedures. The transition from
ICD-9 to ICD-10 involves expanding medical diagnosis codes from the
current 14,000 to more than 67,000, and procedure codes from 13,000
to 85,000.
Marilyn Tavenner, the acting administrator of the Centers for
Medicare and Medicaid Services, told a conference of the American
Medical Association (AMA) that her agency could delay adoption of
the ICD-10 system. Current law calls for physicians to adopt the
new codes next year.
"I'm committing today to work with you to re-examine the pace at
which we implement ICD-10," she said to loud applause. "I want to
work together to ensure that we implement ICD-10 in a way that
[meets its] goals while recognizing your concerns."
Critics - including the AMA - say switching to ICD-10 coding
will require doctors' offices to deal with some 68,000 codes, more
than five times the current 13,000. The change, according to the
AMA, would cost medical practices anywhere between $83,290 and more
than $2.7 million, depending on size.
Speaking to reporters after her prepared remarks, Tavenner said
her office would formally announce its intention to craft new
regulations "within the next few days."
LTC Provider University will provide updates when they
become available.
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Monday February 13, 2012
On January 13, 2012 CMS published a
pair of transmittals that revise Chapter 8, section 40.1 of the
Medicare Benefit Policy Manual to add physician assistants to the
list of practitioners that can perform the
required initial certification and periodic recertifications of the
need for skilled nursing facility (SNF) level of
care.
On January 13, 2012 CMS issued Transmittal
153,
entitled -"Allowing Physician Assistants to Perform Skilled Nursing
Facility (SNF) Level of Care Certifications and
Recertifications". The transmittal provides guidance
on the ability of physician assistants to perform level of care
certifications and recertifications in skilled nursing facilities.
The guidance implements Section 3108 of the Affordable Care
Act. According the guidance, a physician assistant may
now perform the certification or recertification if the physician
assistant collaborates with the physician but does not have a
direct or indirect employment relationship with the facility.
Please review the following two
attachments for details.
Physician Assistants
January 13, 2012
Physician Assistants
Flyer
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Monday February 13, 2012
The Centers for Medicare and Medicaid Services (CMS) has
recently issued an updated S&C memo on reporting the reasonable
suspicion of a crime.
This memorandum informs SAs of the new section 1150B of the Act,
which was established by section 6703(b)(3) of the Affordable Care
Act and is entitled "Reporting to Law Enforcement
of Crimes
Occurring in Federally Funded Long-Term Care Facilities." In
order to promote timely application of the protections offered by
section 1150B of the Act for LTC facility residents, CMS is
explaining now the current obligations of LTC facilities to comply
with the law as it is plainly written, without any delay that might
be occasioned by waiting for any administrative rule-making process
that might further clarify application of the law.
The updates appear in the Definitions and Questions and Answers
sections.
In the definitions, the terms "agent" and "contractor" are
further defined in Appendix One. These definitions will assist
providers in determining who is included in "covered individuals."
In the Q&A section of the memo, additional clarity is
provided regarding the role of the facility in reporting the
suspicion of a crime. It should be noted that this memo
specifically states that a facility may report of a reasonable
suspicion of a crime directly to the state survey agency and law
enforcement on behalf of covered individuals. Additionally, the
Q&A section provides clarity about the impact of this
requirement on ICFs/MR.
Please see the attached S&C letter for more
detailed information.
Reporting Suspicion of Crime 20Jan2012 update
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Friday March 16, 2012
According to F500, if the facility does not employ a qualified
professional person to furnish a specific service to be provided by
the facility, the facility must have that service furnished to
residents by a person or agency outside the facility under an
arrangement, agreement or contract. The arrangement,
agreement, etc. pertaining to services furnished by outside
resources must specify in writing that the facility assumes
responsibility for obtaining services that meet professional
standards and principles that apply to professionals providing
services in such a facility and the timeliness of the
services.
Therefore the facility is required to have contracts with all
third party vendors that provide contract services. Contracts
should include at a minimum:
- Clarification of services/scope of work
- Timeliness of the services
- Payment arrangements of the services/compensation
- Clarification of reporting/documentation requirements, if
applicable
- Staff training requirements, screening, licensure, etc., if
applicable
- Contract terms
- Period of agreement
- Termination of agreement
From the risk management perspective, the following terms should
be included in the contract:
- Independent Contractor provision - this agreement clarifies
that the contractor is not a facility employee and therefore not
subject to the facility's worker's compensation benefits or
professional liability insurance coverage.
- Hold Harmless/Indemnification provision - this agreement
clarifies that one or both parties agree to not hold the other
responsible for damages. This agreement indemnifies one or
both parties by agreeing to not hold the other responsible for any
legal liability or looses as a result of a specified incident or
action.
- Insurance coverage by both parties - this clause states that
each entity will carry their own general/professional liability
insurance. This provision without a hold harmless/indemnification
clause is only helpful if both the facility and the 3rd
party contractor are co-defendants. In other words, if the
3rd party contractor is not a party to a claim against
the facility, the 3rd party contractor's liability
insurance will not hold harmless or indemnify the facility.
In the event an incident/event occurs in which a vendor employee
is involved and a claim arises, the outcome may depend upon the
terms of the contract.
The facility may want to consult with Corporate Counsel on the
appropriate wording for contracts.
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Wednesday April 25, 2012
Federal regulations require that Medicare and Medicaid certified
nursing homes have written emergency plans and provide employees
with emergency preparedness training. In a 2006 report about
nursing homes that experienced hurricanes, the Office of Inspector
General (OIG) found that emergency plans lacked many provisions
recommended by experts. In response, CMS issued guidance checklists
for emergency planning of health care facilities, long-term care
(LTC) ombudsman programs, and State survey agencies (SA). The OIG
conducted this study released April 2012 to assess emergency
preparedness and response of nursing homes that experienced more
recent disasters.
For this study, the OIG analyzed national survey data to
determine compliance with Federal regulations. They also conducted
site visits to 24 selected nursing homes that experienced floods,
hurricanes, and wildfires in 2007-2010. They interviewed nursing
home administrators and staff, local emergency managers, and
representatives from State LTC ombudsman programs and SAs. They
also compared the emergency plans of each selected nursing home to
the CMS checklist for health care facilities.
The OIG found that most nursing homes nationwide met Federal
requirements for written emergency plans and preparedness training.
However, they identified many of the same gaps in nursing home
preparedness and response that were found in the 2006 report.
Emergency plans lacked relevant information including only about
half of the tasks on the CMS checklist. Nursing homes faced
challenges with unreliable transportation contracts, lack of
collaboration with local emergency management, and residents who
developed health problems. LTC ombudsmen were often unable to
support nursing home residents during disasters; most had no
contact with residents until after the disasters. SAs reported
making some efforts to assist nursing homes during disasters,
mostly related to nursing home compliance issues and ad hoc
needs.
The OIG made three recommendations to CMS and one recommendation
to Administration on Aging (AoA). CMS agreed with their
recommendations to revise Federal regulations to include specific
requirements for emergency plans and training, update the State
Operations Manual to provide detailed guidance for SAs on nursing
home compliance with emergency plans and training, and promote use
of the checklists. AoA also agreed with their recommendation to
develop model policies and procedures for LTC ombudsmen to protect
residents during and after disasters.
The top 10 disaster prone states, as ranked by historical
statistics on disaster declarations are Texas, California,
Oklahoma, New York, Florida, Louisiana, Alabama, Kentucky, Arkansas
and Missouri.
Sources: Department HHS Office of Inspector General; CMS;
Long Term Care Ombudsman
The National Long Term Care Ombudsman Resource Center link: http://www.ltcombudsman.org/issues/emergency-preparedness
Office of Inspector General April 2012 Report:
Nursing Home Emergency Preparedness and Response Report
2012
OIG Memo to CMS April 13, 2012:
OIG Emergency Memo April 13-2012
CMS Emergency Preparedness Checklist:
CMS Emergency Preparedness for Every Emergency checklist revised
Sept 2009
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Monday April 23, 2012
It has been recently noted after review of numerous medical
records a common trend has been identified. Residents with
impaired cognition are exhibiting behaviors i.e. screaming out,
resisting care, removing clothes etc. The residents are being
assessed for behavioral interventions and some resident are being
placed on psychoactive medications while pain is the cause of the
resident's behaviors. Residents were not consistently assessed for
pain during the behavioral assessment phase to rule out pain.
Facilities may want to review current systems and processes to
ensure there is an evaluation of the resident for pain with the
onset and/or increase in behaviors. This will also help
in the prevention of unnecessary drugs. See article
below.
Management of Pain In Persons With Dementia
Pain is a common medical condition in older persons; especially
residents in long term care (LTC) settings. Pain is defined as a
sensory and emotional experience associated with actual or
potential tissue damage. Chronic persistent pain occurs in 24% of
LTC residents while only 29% are free of all pain. Most, i.e., 74%,
demented nursing home residents have some pain and the majorities,
i.e., 70%, are untreated
or under-treated.
Pain can have multiple origins; however, discomfort produced by
musculoskeletal disease is the most common problem in the older
person, e.g., arthritis 42%, bone fracture 12%. Untreated or
under-treated pain can produce significant suffering as well
as agitation and
behavioral
problems in persons with dementia. Regular administration of
acetaminophen can reduce agitation in more than one-half of
agitated, demented patients with pain.
Assessment and management of pain is an important responsibility
of any clinical management team. Dementia patients are less likely
to receive analgesics despite the fact that they experience
suffering equal to cognitively intact individuals.
Source: Richard E. Powers, MD (2008) - Bureau
of Geriatric Psychiatryhttp://www.alzbrain.org/
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Monday April 23, 2012
April 30, 2012 is the new deadline for nearly all nursing
facilities and assisted living communities to display posters
informing employees of their rights under the National Labor
Relations Act (NLRA), according to the National Labor Relations
Board. The notice should be posted in a conspicuous place,
where other notifications of workplace rights and employer rules
and policies are posted. Employers also should publish a link to
the notice on an internal or external websites if other personnel
policies or workplace notices are posted
there.
You may download and print the notice using the links below. You
may also call 202-273-0064 and copies will be mailed to you free of
charge.
IMPORTANT INFORMATION ABOUT POSTERS
The poster is required to be 11 x 17 inches, in color or
black-and-white. When printing to full size, be sure to set your
printer output to 11 x 17. Or you may print the two 8.5 x 11 pages
and tape them together.
English Posters
English
Employee Rights Poster 11 x 17 English
Employee Rights Poster 8-5 x 11
Spanish Posters
Spanish
Employee Rights Poster 11 x 17
Spanish
Employee Rights Poster 8-5 x 11
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Wednesday April 11, 2012
On January 4, 2011, President Barack Obama signed into law the
National Alzheimer's Project Act (NAPA), requiring the Secretary of
the U.S. Department of Health and Human Services (HHS) to establish
the National Alzheimer's Project. The law also establishes the
Advisory Council on Alzheimer's Research, Care, and Services and
requires the Secretary of HHS, in collaboration with the Advisory
Council, to create and maintain a national plan to overcome
Alzheimer's disease (AD).
Building on the preliminary work on this plan, on February 7,
2012, the Obama Administration announced a historic $156 million
investment to tackle Alzheimer's disease.
The draft of the National Plan is being submitted to the
Advisory Council for consideration and input. It was also be open
for public comment through March 30, 2012.
To read the draft in its entirety click on the following
link:
Draft
National Alzheimer's Plan 2012
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Monday April 9, 2012
The National Certification Council of Activity Professionals has
implemented an examination that all NEW applicants must complete in
order to apply for national certification at the ADC or ACC
level(s) effective January 1, 2012. Please note that is will not
affect those individuals already certified at any level with NCCAP
prior to December 31, 2011.
The test consists of questions from the nine topic areas and the
163 competencies defined in the MEPAP curriculum. Completion of the
Modular Education Program for Activity Professionals,
2nd Edition will prepare the applicant for the exam.
There will be 50 questions on the test and applicants will have one
(1) hour to complete the test. Applicants must make a 70% to pass
the exam. Comira and ACT testing centers will administer the
examination and they are located throughout the United States and
Canada.
For additional information regarding the new testing policy and
procedure please contact the NCCAP office or visit their web site
at www.nccap.org
Source: National Certification Council for Activity
Professionals
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Monday April 9, 2012
The average flu vaccination rate among nursing home residents
nationwide was 72 percent during the 2005-2006 flu season. This was
well below the Healthy People 2010 goal of 90 percent. A new study
found that black nursing home residents have lower flu vaccination
rates than their white counterparts. It found that over three
consecutive flu seasons (2006-07, 2007-08, and 2008-09), the odds
of being vaccinated were 14-16 percent lower for blacks than for
whites within the same facility.This difference persisted even
after excluding residents who were either offered but declined
vaccination, or were vaccinated outside the facility.
The Brown University researchers also found that nursing homes
with high proportions of black residents had lower vaccination
rates for both blacks and whites than did facilities with lower
proportions of black residents. These facilities generally have a
high proportion of Medicaid residents. Therefore, they have less
revenue and fewer opportunities to cross-subsidize care with income
from more profitable Medicare and private-pay patients.
The researchers suggest that low revenue, insufficient staffing,
and poor-quality performance may all contribute to the lower
vaccination rates in these facilities. They also point out that
blacks are consistently more likely than whites to refuse flu
vaccinations when offered. To completely eliminate racial
differences in flu vaccination rates, educational programs that
focus on elderly blacks and their families may be necessary,
suggest the researchers. Their study was supported in part by the
Agency for Healthcare Research and Quality (HS16094).
Source: Agency for Healthcare Research and
Quality http://www.ahrq.gov/research/apr12/0412RA23.htm
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Tuesday April 3, 2012
The Registered Nurses Association of Ontario (RNAO) and the
guideline development panel have compiled a list of implementation
strategies to assist health-care organizations or health care
providers that are interested in implementing this guideline.
According to the RNAO, this nursing best practice guideline is a
comprehensive document, which provides resources necessary for the
support of evidence-based nursing practice. The document must be
reviewed and applied, based on the specific needs of the
organization or practice setting/environment, as well as the needs
and wishes of the client. This guideline should not be applied in a
"cookbook" fashion, but rather as a tool to enhance decision-making
in the provision of individualized care. In addition, the guideline
provides an overview of appropriate structures and supports
necessary for the provision of best possible care.
The purpose of this best practice guideline is to provide
evidence-based recommendations for Registered Nurses and Registered
Practical Nurses on best nursing practices for end-of-life care
during the last days and hours of life. The guideline does not
replace consultation with palliative care specialists, who can
support nurses to provide quality end-of-life care. The guideline
is intended to be a resource to nurses who may not be experts in
this practice area. It is acknowledged that individual competencies
vary between nurses and across categories of nursing professionals.
The inclusion of recommendations on clinical, education,
organization and policy topics makes this guideline applicable to
nurses in all domains and settings of practice
Source: Agency for Healthcare Research and Quality
End of Life Care During the Last Days and Hours
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Monday April 2, 2012
WEDNESDAY, March 28 (HealthDay News) -- Antipsychotic drugs can
raise the risk of heart attack in older patients with dementia, a
new study suggests.
It's common to prescribe antipsychotics to older patients with
dementia to control symptoms such as agitation, hallucinations and
aggression. Previous studies have found that this use of the drugs
may be linked to an increased risk of stroke and death from all
causes.
But until now, the risk of heart attack associated with the use
of antipsychotic drugs in older people with dementia had been
"poorly examined," wrote study author Dr. Antoine Pariente, of
Universite Bordeaux Segalen in France, and colleagues.
They looked at nearly 11,000 patients, aged 66 and older, in
Quebec who were being treated with cholinesterase inhibitors for
dementia and were also prescribed antipsychotics.
Within a year of starting treatment with the antipsychotics, 1.3
percent of the patients had a heart attack. Compared to those not
taking antipsychotics, the risk of heart attack among those taking
them was 2.19 times higher for the first 30 days, 1.62 times higher
for the first 60 days, 1.36 times higher for the first 90 days, and
1.15 times higher for the first year.
"Our study results indicate that the use of [antipsychotic
medications] is associated with a modest increase in the risk of
[heart attack] among community-dwelling older patients with treated
dementia," the researchers wrote. "The increased risk seems to be
highest at the beginning of treatment and seems to decrease
thereafter, with the first month of treatment accounting for the
highest period of risk."
The study, which found an association between antipsychotic use
and heart attack but did not prove cause-and-effect, appeared
online March 26 in the Archives of Internal Medicine.
"Because [antipsychotic] use is frequent in patients with
dementia ... the increased risk of [heart attack] may have a major
public health effect, which highlights the need for communicating
such risk and for close monitoring of patients during the first
weeks of treatment," the authors concluded in a journal news
release.
Further research is required to learn more about why the use of
antipsychotic drugs in dementia patients may increase the risk of
heart attack, Dr. Sudeep Gill and Dr. Dallas Seitz, of Queen's
University in Kingston, Ontario, Canada, wrote in an accompanying
editorial.
"Meanwhile, physicians should limit prescribing of antipsychotic
drugs to patients with dementia and instead use other techniques
when available, such as environmental and behavioral strategies, to
keep these patients safe and engaged," they suggested.
While the study found an association between antipsychotic drugs
and heart attack risk, it did not prove a cause-and-effect
relationship.
SOURCE: JAMA/Archives journals, news release, March 26, 2012
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Wednesday May 30, 2012
The purpose of Enforcement Procedures for Investigating or
Inspecting Workplace Violence Incidents is to provide general
policies and procedures that apply when workplace violence is
identified as a hazard while conducting an inspection under a
national, regional or local emphasis program and when responding to
incidents of workplace violence, especially when conducting
inspections at worksites in industries with a high incidence of
workplace violence.
Workplace violence is recognized as an occupational hazard in
some industries and environments which, like other safety issues,
can be avoided or minimized if employers take appropriate
precautions. At the same time, it continues to negatively impact
the American workforce. Workplace violence has remained among the
top four causes of death at work for over fifteen years, and it
impacts thousands of workers and their families annually.
Research has identified factors that may increase the risk of
violence at worksites. Such factors include working with the public
or volatile, unstable people. Working alone or in isolated areas
may also contribute to the potential for violence. Handling money
and valuables, providing services and care, and working where
alcohol is served may also impact the likelihood of violence.
Additionally, time of day and location of work, such as working
late at night or in areas with high crime rates, are also risk
factors that should be considered when addressing issues of
workplace violence.
Click the link below for the complete report:
Enforcement Procedures for Investigating or Inspecting Workplace
Violence Incidents
-
Tuesday May 29, 2012
The Falls Management
Program (FMP) is an interdisciplinary quality improvement
initiative. It is designed to assist nursing facilities in
providing individualized, person-centered care, and improving their
fall care processes and outcomes through educational and quality
improvement tools. Many nursing facilities have fall programs in
place, but recognize that there is always room for improvement.
While not all falls and injuries can be prevented, it is critical
to have a systematic process of assessment, intervention and
monitoring that results in minimizing fall
risk.
Source: Agency for
healthcare Research and Quality
(AHRQ)
-
Friday May 25, 2012
For
more than 20 years, the Beers Criteria for
Potentially Inappropriate Medication Use in Older
Adults has been the leading source of
information about the safety of prescribing drugs for older people.
To help prevent medication side effects and other drug-related
problems in older adults, the American Geriatrics Society (AGS) has
updated and expanded this important resource. The
expanded AGS Updated Beers Criteria for
Potentially Inappropriate Medication Use in Older
Adults identifies medications
with risks that may be greater than their benefits for people 65
and older.
This summary is from the
full report titled,
AGS Updated Beers Criteria for Potentially Inappropriate Medication
Use in Older Adults. It is in the March
2012 issue of the
Journal of the American Geriatrics Society
(JAGS). The report is authored
by the American Geriatrics
Society
Click Link
Below for Summary:
Beers Criteria -
Updated 2012
-
Thursday May 10, 2012
Free Online Training for MDS 3.0 Section M: Skin Condition
This FREE video and handouts of the pressure ulcer assessment
and coding training session for MDS 3.0 Section M: Skin Condition
was delivered in Las Vegas on August 10, 2010. It was posted
online by the Centers for Medicare and Medicaid Services (CMS) on
January 20, 2011. This lecture was part of the CMS
sponsored introduction to MDS 3.0. If you still want
access to the information it is posted on YouTube! The link is
posted below with the slides/handouts.
You can view the slides/handouts, watch the video, and get free
in-depth training on this important topic for resident assessment
in long-term care. The lecture is 1 hour and 42 minutes
long and reviews all aspects of prevention, wound identification,
staging, and coding, including sample coding challenges and wound
quiz.
You Tube link to video:
http://www.youtube.com/watch?v=7km6NHbVxHs
Handouts/slides:
MDS 3.0
Training Slides 2 Section M
MDS 3.0
Section M Study Aid
MDS
3.0 Training Slides Section M
-
Friday June 29, 2012
Dementia Incidences to Triple Says World Health
Organization
The World Health Organization has released data on the
current state of dementia care worldwide and the prevalence of the
disease, both currently and in the future. Among other findings,
researchers predict the number of people with dementia worldwide to
triple by 2050.
The World Health Organization compiled the results of a number
of studies in a new report about the prevalence, effects, and
implications of dementia. According to the report, in 2010 35.6
million people worldwide had dementia, a number expected to nearly
double every 20 years. In 2010 the worldwide costs of dementia were
estimated to be 604 billion US dollars, a number also expected to
grow over the coming years. Despite the high social and financial
costs, only eight countries have national programs to address
dementia.
The report emphasizes that a variety of services, including
caregiver support programs, residential care communities, and
palliative care options, are needed to serve those with dementia.
High-income countries are generally able to provide more options
for citizens, but the report makes it clear that even high-income
countries have room for improvement. For example, seven out of
eight survey respondents from high-income countries report that
their country provides support for residential care, but many of
these countries do not provide sufficient care. Poland, for
instance, only reported one community specifically designed for
individuals with dementia.
Read the full report: Dementia: A Public Health
Priority
-
Monday June 18, 2012
Current guidance in Appendix PP of the State Operations Manual
for Tag F 492, 42 CFR §483.75(b) and (c) States that this tag
should be cited only when the authority having jurisdiction has
both made a determination of noncompliance and has
taken a final adverse action as a result. There has been confusion
as to whether this requirement may be cited when a facility simply
does not meet a State regulation. This memorandum clarifies and
revises the Centers for Medicare & Medicaid Services (CMS)
guidance to Surveyors in Appendix PP of the SOM regarding citations
under Tag F492.
June 1, 2012 CMS issued a revision and clarification to the
Interpretive Guidance for F492. The effective date of this memo is
immediately. These changes will be incorporated into the next
revision of Appendix PP of the SOM. Please read the attached
document for details.
Revised Guidance for
F492
-
Tuesday June 5, 2012
All long term care providers and operators have an obligation to
prepare for potential disasters. Each facility is unique with
regard to the types of residents/clients served, geographical
location, types of disasters to plan for and proximity to local
assistance. Preparation, education, and practice are the keys to a
well-managed event involving a catastrophic occurrence that comes
with little or no warning.
We have recently added numerous documents, forms, and guides to
assist health care facilities in this planning process. These forms
are located behind the "Risk Management Resource Center" door. We
remind all facilities that any workable disaster plan must be
tailored to the individual facility. It is advised that a committee
be formed to develop and analyze all material for the manual, as
well as provide regular reviews and updates. The following
documents posted are:
- Nursing Home Incident Command System (NHICS)
- Guidebook
- Incident Management Team
- Position Crosswalk
- Quick Guide to Job Responsibilities
- Incident Briefing & Operational Log
- Incident Objectives
- Organization Assignment List
- Incident Communications Plan
- Staff Injury Plan
- Organizational Chart
- Incident Message Form
- Facility System Status Report
- Personnel Time Sheet
- Volunteer Staff Registration
- Master Emergency Admit Tracking Form
- Master Resident Evacuation Tracking Form
- Procurement Summary Report
- Resource Accounting Record
- Facility Resource Directory
- Master Facility Casualty Fatality Report
- Resident Evacuation Tracking Form
- Incident Action Safety Analysis
- Emergency Water Supply Planning Guide
- National Criteria for Evacuation Decision - Making in Nursing
Homes
- Caring for Vulnerable Elders During A Disaster - Hurricane
Summit
Listed below are links to also assist you in locating additional
information that you may require:
FEMA:
http://www.fema.gov/
Homeland Security:
http://www.dhs.gov/files/prepresprecovery.shtm
American Red Cross Preparedness Fast Facts:
http://www.redcross.org/portal/site/en/menuitem.86f46a12f382290517a8f210b80f78a0/?vgnextoid=92d51a53f1c37110VgnVCM1000003481a10aRCRD
Kentucky All Hazards Long Term Care Planning & Resource
Manual:
http://www.kahsa.com/Kentucky-All-Hazards-Long-Term-Care-Planning-%26-Resource-Manual-p-373.html
California Association of Health Facilities - Disaster
Preparedness Program: http://www.cahfdisasterprep.com/PreparednessTopics.aspx
Florida Health Care Association - Emergency Preparedness Tools:
http://www.fhca.org/facility_operations/emergency_preparedness_tools/
http://www.fhca.org/emerprep/index.php
National Nurse Emergency Preparedness Initiative:
http://www.nnepi.org/index.htm
Texas Health Care Association-Disaster Preparedness Tools: http://www.txhca.org/disasterpreparedness.htm
-
Friday June 1, 2012
The Centers for Medicare & Medicaid Services (CMS) has
recently received reports of use of insulin pens for more than one
patient, with at least one 2011 episode resulting in the need for
post-exposure patient notification. These reports indicate that
some healthcare personnel do not adhere to safe practices and may
be unaware of the risks these unsafe practices pose to patients.
Insulin pens are meant for use by a single patient only. Each
patient/resident must have his/her own. Sharing of insulin pens is
essentially the same as sharing needles or syringes, and must be
cited, consistent with the applicable provider/supplier specific
survey guidance, in the same manner as re-use of needles or
syringes.
The Centers for Disease Control and Prevention (CDC) has also
become increasingly aware of reports of improper use of insulin
pens, which places individuals at risk of infection with pathogens
including hepatitis viruses and human immunodeficiency virus (HIV).
This notice serves as a reminder that insulin pens must
never be used on more than one person.
Follow the link to visit the CDC page on Injection
Safety:
http://www.cdc.gov/injectionsafety/clinical-reminders/insulin-pens.html
CDC Insulin Pen Poster:
Clinical Reminder for Use of Insulin pen
CMS Survey & Certification letter on Insulin pens:
Use of Insulin Pens May 18 2012
-
Wednesday July 11, 2012
Suicide is tragic. It cuts a life short, and it devastates the
family, friends and loved ones left behind. Those who survive a
suicide attempt might end up with severe disability or other
injuries. The children of people who die by suicide are more likely
to later die by suicide themselves. With such extreme consequences,
why would anyone make the dire decision to choose death over
life?
That's a question scientists have been struggling to answer for
decades. "When you're in a suicidal state, you're kind of closing
down your options. You see it as the only solution. You're not
really able to entertain other ideas," says Dr. Jane Pearson, who
heads a suicide research consortium at NIH. "What's the science
behind that? What's happening in the brain that leads people to
think so dysfunctionally?"
Recognizing those at risk is essential. Suicide is the
10th leading cause of death nationwide, and it's the 3rd leading
cause of death among adolescents. Nearly 37,000 Americans died by
suicide in 2009, according to the U.S. Centers for Disease Control
and Prevention. More than half of those deaths were from
firearms.
People of all genders, ages and ethnicities are at risk for
suicide. Women are more likely than men to attempt suicide, but men
are more likely to die by suicide. That's because men often choose
deadlier methods, such as firearms or suffocation.
"The highest risk groups are older men," says Pearson.
"In fact, white men who are 85 and older have a rate of suicide
that's 4 times the national average."
To read the entire NIH report in this
attachment.
-
Monday July 9, 2012
Memorandum Summary
- Quality Assurance and Performance Improvement (QAPI)
Activities: Section 6102(c) of the Affordable Care
Act mandates the Centers for Medicare & Medicaid Services (CMS)
to establish standards and provide technical assistance to nursing
homes on the development of best practices relating to QAPI. The
CMS put forth several initiatives to implement these provisions
that include:
- Refinement of QAPI Tools and Resources:
Ongoing development of QAPI tools and resources that nursing homes
may use to design and implement an effective QAPI program.
- Launch of a QAPI Demonstration:
Demonstration project in 17 nursing homes in 4 States to test tools
and resources and provide technical assistance to nursing homes in
QAPI implementation.
- Rollout of QAPI materials: CMS will
release materials later this calendar year that will support
nursing homes in QAPI implementation.
- Draft of the QAPI Regulation: CMS is in
the process of drafting a new QAPI regulation.
- Launch of the Nursing Home Quality Improvement
Questionnaire: The CMS has launched a nursing home
quality improvement questionnaire using an independent
contractor. The data collection period is from June 25
through September 28, 2012.
-
Tuesday July 24, 2012
This study used a random sample of records from a previous
Office of Inspector General (OIG) study of elderly nursing facility
residents with Medicare claims for atypical antipsychotic drugs
between January and June 2007. They reviewed the records for
evidence of compliance with Federal requirements for resident
assessments and documentation of decision-making. They also
reviewed the records for evidence of compliance with Federal
requirements for care plan development and implementation.
Nearly all records reviewed (99 percent) failed to meet one or
more Federal requirements for resident assessments and/or care
plans. The resident assessment and care plan process involves four
steps. One-third of records reviewed did not contain evidence of
compliance with Federal requirements regarding resident
assessments, the first step. Further, for 4 percent of records,
nursing facility staff did not document consideration of the
Resident Assessment Protocol for psychotropic drug use as required,
the second step. Ninety-nine percent of records did not contain
evidence of compliance with Federal requirements for care plan
development, the third step. Finally, 18 percent of records
reviewed did not contain evidence to indicate that planned
interventions for antipsychotic drug use-the fourth step-actually
occurred.
Please read the following attachments for more details and
CMS response to the report.
OIG Report Care Plans for Residents Receiving Atypical
Anitpsychotic Drugs
-
Tuesday August 14, 2012
INTERACT
(Interventions to Reduce
Acute Care
Transfers) is a quality improvement program that
focuses on the management of acute change n resident condition.
The INTERACT
program is designed to improve the early identification,
assessment, documentation, and communication about changes in the
status of residents in skilled nursing facilities.
The INTERACT goal
is to improves care and reduce the frequency of potentially
avoidable transfers to the acute hospital. Transfers to the
hospital can be emotionally and physically difficult for residents,
and result in numerous complications of hospitalization, and they
are costly.
In the plans for health care reform, Medicare may financially
reward facilities with lower hospitalization rates for certain
conditions. By improving the identification, evaluation, and
communication about changes in resident status, some, but not all
acute care transfers can be avoided.
The attached pdf Transitions and Long-Term Care:
Reducing Preventable Hospital Readmissions Among Nursing Facility
Residents explains what INTERACT is and how to use
the quality improvement tool.
Reducing Preventable Hospital Readmissions Among Nursing Facility
Residents
TheINTERACT web
site; www.interact2.net is
a free web site for facility use in decreasing acute care
transfers. The web site contains information about INTERACT,
INTERACT II Tools, Educational Resources, and Links to Other
Resources.
-
Wednesday September 5, 2012
Please read the following reminder regarding the Medicare
Secondary Payer Act. Medicare
Secondary Payer Act Reminder
-
Wednesday September 5, 2012
On August 28, 2012 the Centers for Medicare and Medicaid
Services (CMS) released their 2012 Nursing Home Action Plan. The
plan is organized into 5 actionable strategies:
- Enhance Consumer Engagement.
- Strengthen Survey Processes, Standards, and Enforcement.
- Promote Quality Improvement.
- Create Strategic Approaches through Partnerships.
- Advancing Quality through Innovation and
Demonstration.
Details include planned updates to Nursing Home Compare, improving
fire safety, revising surveyor guidance, QIS, civil money
penalties, culture change activities, QAPI, Care Transitions,
Health Facility Acquired Infections (HAIs), and initiatives for
reducing re-hospitalizations and use of anti-psychotics. The
plan is based on a 3-part plan created by the agency to improve the
U.S. health care system:
- Improving the individual experience of care.
- Improving the health of populations.
- Reducing the per-capita cost of care of populations.
Complete 2012 Nursing Home Action Plan: 2012-Nursing-Home-Action-Plan
-
Wednesday September 5, 2012
In 2012, CMS launched the Partnership to Improve
Dementia Care in Nursing Homes to promote comprehensive dementia
care and therapeutic interventions for nursing home residents with
dementia-related behaviors. The goals of this initiative include a
focus on person-centered care and the reduction of unnecessary
antipsychotic medication use in nursing homes and eventually other
care settings as well.
CMS is using several approaches to successfully implement
this initiative. CMS is developing and conducting trainings for
nursing home providers, surveyors, and consumers. We are conducting
research, raising public awareness, using regulatory oversight, and
public reporting to increase transparency.
-
Friday September 7, 2012
Registration is now open for the 2012 CQRMS Training
Program. If you would like more information about this
program please contact Nancy Lee (contact information listed in the
brochure).
Seating is limited, early registration is recommended.
Registration brochure: 2012 CQRMS web
brochure
-
Friday September 14, 2012
Hand Hygiene (HH) has always been a concern in long term care
facilities and recently, in some states, there has been an increase
in the number of citations being written related to HH. A recent
article published in the Journal of Applied Gerontology,
titled "Hand Hygiene Deficiency Citations in Nursing
Homes" addresses this area of concern.
Click on the link below to take you to the article.
http://jag.sagepub.com/content/early/2012/08/01/0733464812449903.abstract
-
Friday September 14, 2012
The healthcare industry faces enormous pressure to
transform the delivery system from acute centric care into more
cost effective care across the preventative, chronic, acute, and
long-term continuum. The marketplace is demanding that providers
align, and that change is implemented aggressively. The current
industry backdrop is an environment where the cost of drugs,
supplies, technologies and staffing are increasing, competition
from entrepeneurs who capture opportunities in attractive niches is
intensified, and consumer interest in public scorecards on hospital
and physician safety, quality, and satisfaction has risen. All the
while reimbursement rates from third party payors (Medicare,
Medicaid, and Commercial Health Plans) is trending
downward.
To continue reading this article, click the link below:
Transition to
ICD 10
-
Tuesday September 18, 2012
Please see the two attachments regarding a recent lawsuit
involving alleged off-labeled use of an antipsychotic and a press
release from the U. S. Department of Justice in which a company
maintained specialized sales force to market drug for off label
purposes; Targeted elderly dementia patients in nursing homes.
Alert-CMS Initiative for the Use of Antipsychotics
subject of lawsuit
U.S. Department of Justice Press
Release