Category: Long Term Care Blog

CMS Memo: QSO-19-10-NH

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Specialized Infection Prevention and Control Training for Nursing Home Staff in the Long-Term Care Setting is Now Available

  • The Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) collaborated on the development of a free on-line training course in infection prevention and control for nursing home staff in the long-term care setting.
  • The training provides approximately 19 hours of continuing education credits as well as a certificate of completion.
  • The “Nursing Home Infection Preventionist Training Course” is located on CDC’s TRAIN website (www.train.org/cdctrain/training_plan/3814).
  • This memo supersedes memo Quality, Safety & Oversight policy memorandum QSO 18-15-NH.

Please see the memo for further details.

Provider Feedback Survey

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The Section for Long-Term Care Regulation is again seeking input from long-term care providers. We are asking for your help in identifying areas in our Section where excellent customer service is provided and areas where we need to focus on improving our customer service experience. Please take a couple minutes to complete our 2019 Provider Feedback Survey at https://www.surveymonkey.com/r/RRR9NG9 by June 30, 2019.

ICD-10 Bootcamp: Basic and Advanced Workshops

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ICD-10 Bootcamp – Advanced

May 23, 2019: Independence
June 13, 2019: Columbia
July 11, 2019: Springfield
August 13, 2019: St. Louis

This one-day bootcamp is designed for individuals with some coding experience. The session will walk individuals through various coding scenarios, including scenarios with common coding errors found during First Class Solutions, Inc. SNF coding audits. Case scenarios will also include PDPM specifics such as clinical categories and NTA comorbidities.

 

ICD-10 Bootcamp – Just the Basics

June 11-12, 2019: Columbia

This two-day bootcamp is designed for individuals with minimal ICD-10 coding experience. The bootcamp will review SNF relevant coding guidelines and coding conventions. Attendees will participate in case scenarios that utilize the coding conventions and guidelines, and address PDPM coding specifics.

Pioneer Network’s Hot Topics: Culture Change in Action

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July 18, 2019: Applying Person-Centeredness to Trauma-Informed Care: A planned person-centered approach to the new CMS Trauma-Informed Care Regulations
Guide: Cynthia E. Baker, MSW, LCSW, LSCSW, LIMHP, and CSW-Gerontology, Regional Clinical Manager for Deer Oaks Behavioral Health

This 60-minute webinar describes person-centered trauma-informed care as it relates to this year’s newest phase of CMS regulation regarding Trauma-Informed care. §483.25 effective Nov. 28, 2019.

The presenter will identify types trauma events, educate about physical and mental manifestations of trauma, and provide strategies for person-centered response plans when residents disclose trauma histories.

Attendees will leave the webinar with interpretation of the trauma-informed guidelines, related F tags, interpret the Behavioral and Emotional Status Critical Element Pathway used by state survey, assessment tools for staff, and apply four actions steps to prepare your community for person centered trauma informed care.

National Emerging Leadership Summit

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July 16-18, 2019: The 2019 National Emerging Leadership Summit
Location: Washington D.C.

The 10th annual National Emerging Leadership Summit (NELS) for Health and Aging Services Executives will be held in Washington, D.C. from July 16-18, 2019. The three-day summit, unique in its kind, is geared towards the enrichment of leadership skills for emerging health service executives working in skilled nursing facilities, assisted living centers, continuing care retirement communities, life plan communities, rehabilitation hospitals, home- and community-based services, and more. Summit participants will enjoy an engaging, interactive experience that is focused on hearing their voice and helping them grow professionally, all while crafting solutions to improve the field of health and aging services and the profession of administration and leadership therein. Sponsors for this year’s Summit include ACHCA, NAB, AHCA/NCAL, Argentum, LeadingAge, and NIC, as well as several university partners. We are grateful to our wonderful Summit partners and sponsors for their support to make NELS an exciting event each year.

The complete Summit package includes approximately 19 CE credits for administrators from the National Association of Long-Term Care Administrator Boards (NAB), admission to all speaker events and presentations, breakfast and lunch each day, a reception with past NELS attendees and leaders in health and aging services, and a unique Washington, D.C. group event and dinner one evening. Lodging information at the host hotel, with the NELS discounted rate, will be provided upon application and acceptance (each participant will reserve his/her own room in the room block). For more information and how to apply to attend the 2019 NELS Summit, you can visit the NELS website at: www.nelssummit.org/. Limited scholarship support is available, which covers the registration fee, with a link to a scholarship application found on the “How to Apply” page on the website. The 2019 NELS application deadline is Friday, May 24, 2019. Questions regarding the NELS Summit can be sent to Kevin Hansen, NELS Director, at hansekev@uwec.edu or to Doug Olson, NELS Senior Advisor, at olsondou@uwec.edu.

Department of Mental Health PASRR Level II Assessment Webpage

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The DMH PASRR Level II Assessment webpage is a resource to assist Nursing Facilities with the level II process and care planning for behavioral and mental health conditions. The web page includes an overview of the preadmission screening and resident review process, reporting requirements for NF, who to contact for assistance, how to file an appeal, where to find answers to FAQ and links to crisis planning and other resources.

Please visit the website at https://dmh.mo.gov/programs.html.

Conversations with Carmen

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May 17, 2019: Real Babies and Children; How to Welcome Children All the Time
Guest: Angie McAllister, Director of Quality of Life and Culture Change Operations, Signature HealthCARE

This month learn how to successfully incorporate children into the life of a nursing home from Angie McAllister. She will also share ways to welcome employees’ children and host camp all summer long. Join Angie and Carmen for this illuminating discussion about adding more Real Life to the care environment.

Payroll-Based Journal (PBJ) Deadline

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The submission deadline for PBJ is approaching. PBJ data for 1/1/19 through 3/31/19 is due on May 15, 2019. CMS uses PBJ data to determine each facility’s staffing measure on the Nursing Home Compare tool on Medicare.gov website, and calculate the staffing rating used in the Nursing Home Five Star Quality Rating System.

More information about PBJ can be found on the CMS webpage www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Staffing-Data-Submission-PBJ.html.

SNF QRP Deadline

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The submission deadline for the SNF Quality Reporting Programs (QRP) is approaching. MDS data for October 1 – December 31 (Q4) of calendar year (CY) 2018 are due with this submission deadline. All data must be submitted no later than 11:59 p.m. Pacific Standard Time on May 15, 2019.

As a reminder, it is recommended that providers run applicable validation/analysis reports prior to each quarterly reporting deadline, in order to ensure that all required data has been submitted.

CORMAC sends informational messages to IRFs, LTCHs, and SNFs that are not meeting APU thresholds on a quarterly basis ahead of each submission deadlines. If you need to add or change the email addresses to which these messages are sent, please email QRPHelp@cormac-corp.com and be sure to include your facility name and CMS Certification Number (CCN) along with any requested email updates.

REVISED Nursing Facility Level of Care Update and Release of Draft Algorithm 2.0 – Feedback Requested

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In response to feedback to the original draft Nursing Facility Level of Care algorithm, revisions have been made and a revised version, Version 2.0, has been developed. Please review the draft algorithm and accompanying documents and provide feedback as directed below. Your feedback is critical to this process.

In addition to the actual revised algorithm, a level of care determination guide has been developed to serve as a summary of the DRAFT LOC Algorithm 2.0. This guide serves as a blueprint for stakeholders and participants to understand proposed LOC updates. (The DRAFT LOC Algorithm 2.0 along with the InterRAI Home Care assessment tool is specific and should be used to determine a participant’s LOC.)

InterRAI Home Care – MO Version PW
DRAFT LOC 2.0 Algorithm
Nursing Facility Level of Care (LOC) Determination Guide 4-16-2019
Participant Worksheet

Please submit feedback until May 20, 2019, by emailing your participant worksheets, determination guides and comments to LOCTransformation@health.mo.gov.

The password for the InterRAI Home Care assessment tool and any questions regarding the revised algorithm may be sent to slcr@health.mo.gov.

2019 Pioneer Network Conference – Pioneer Connection

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PIONEER CONNECTION: We know that over the years pioneers have traveled in search of new and exciting opportunities in horse drawn wagons, canoes and on foot. As a modern Pioneer seeking the answers to Pioneering a New Culture of Aging, how about traveling to the 2019 annual conference in Louisville, KY in a luxury motor coach? Please see the flyer for more details.

Pioneer Network’s Hot Topics: Culture Change in Action

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June 25, 2019: It’s Happening: How Anti-Ageism Activists are Changing the Culture of Aging! (FREE WEBINAR)
Guide: Ashton Applewhite, Anti-Ageism Activist

Join us for an interactive discussion with nationally known author and anti-ageism activist Ashton Applewhite about what’s happening in the movement to change the culture of aging. We’ll talk about international and domestic campaigns to dismantle ageism, and how pro-aging advocates can find resources, confront our own internalized ageism, participate in these initiatives, and help build a better world in which to grow old.

Pioneer Network’s Hot Topics: Culture Change in Action

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May 23, 2019: Person Centered Dementia Care: First Came the Recommendations, Now Let’s Explore the Outcomes!
Guides: Sam Fazio, Senior Director of Quality Care and Psychosocial Research Care and Doug Pace, MHA, Director of Mission Partnerships, Alzheimer’s Association

The Dementia Care Practice Recommendations were released over a year ago. Join Sam Fazio and Doug Pace from the Alzheimer’s Association as they share data and stories of what has happened over the past year as these recommendations have been put into practice. You will learn how these standards can be the basis of a culture of quality improvement that can be achieved in any long-term care or community-based setting. In addition, as sponsors of the Dementia Track at this year’s Pioneering a New Culture of Aging conference, Sam and Doug will share with you some of the highlights from of what’s happening in the world of Dementia Care that will be shared at this year’s conference.

Pioneer Network’s Hot Topics: Culture Change in Action

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April 17, 2019: The Double Whammy of Ageism and Ableism (FREE WEBINAR)
Guide: Mel Coppola

By now, you’ve probably heard some buzz around ageism-the prejudice of people based on their age. And hopefully you have gained some awareness around it and are taking steps against it—after all, you WILL grow old. But how much have you thought about ableism-the prejudice of someone based on their different abilities, whether physical or cognitive? None of us want to think of ourselves as prejudiced, but we make assumptions based on age and ability more than we think. Especially in the work that we do, these two “isms” collide on a daily basis. In this webinar, we will discuss the intersection of ageism and ableism and the double whammy it has for the people we support.

TMF QIN Webinar on Antipsychotic Medication Reduction

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April 16, 2019: Antipsychotic Medication Reduction: A Psychiatrist’s Pearls for Progress, Challenges and Continued Improvement
Presenter: Ellen Fan, MD, Geriatric psychiatrist

Join this physician-directed webinar to learn more about assessing and evaluating appropriate anti psychotic medication use in nursing home residents, as well as applying strategies toward behavior management and anti psychotic medication reduction.  *Attendees will have the opportunity to earn 1.0 continuing education credit.*

Multiport USB Chargers

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We are starting to see more wall-plugged multiport USB chargers. These chargers meet the 2012 edition of NFPA 99’s definition of a Multiple Outlet Connection, under the 10.2.3.6 requirements.

10.2.3.6 Multiple Outlet Connection. Two or more power receptacles supplied by a flexible cord shall be permitted to be used to supply power to plug-connected components of a movable equipment assembly that is rack-, table-, pedestal-, or cart-mounted, provided that all of the following conditions are met:

  • The receptacles are permanently attached to the equipment assembly.
  • The sum of the ampacity of all appliances connected to the outlets does not exceed 75 percent of the ampacity of the flexible cord supplying the outlets.
  • The ampacity of the flexible cord is in accordance with NFPA 70, National Electrical Code.
  • The electrical and mechanical integrity of the assembly is regularly verified and documented.
  • Means are employed to ensure that additional devices or non medical equipment cannot be connected to the multiple outlet extension cord after leakage currents have been verified as safe.

NFPA 70, 2011 edition; Definitions: Receptacle. A receptacle is a contact device installed at the outlet for the connection of an attachment plug. A single receptacle is a single contact device with no other contact device on the same yoke. A multiple receptacle is two or more contact devices on the same yoke.

NFPA 70, 2011 edition; Definitions: Plug (Listed as attachment plug and called a plug cap). A device that, by insertion in a receptacle, establishes connection between the conductors of the attached flexible cord and the conductors connected permanently to the receptacle.

*This means multiport USB charges should be treated the same as a power tap/power strip. They must be mounted and/or secured and plugged directly into an outlet. Multiport USB chargers should not be plugged into a power strip or surge protector in a long-term care facility.

Administrator License Renewal

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Missouri licensed administrators (NHA or RCAL) expiring June 30, 2019, are due for license renewal. If you plan to renew, visit our website at www.health.mo.gov/bnha and follow the instructions provided in the Renewal Checklist. Once your renewal has been successfully processed, you will be issued a current license via email. Please note if you fail to renew by June 30, 2019, you cannot practice as a licensed administrator after that date. Visit our website for additional information regarding completing a late renewal.

Conversations with Carmen

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April 19, 2019: Sparking a new Culture of Self-Directed Learning at Work
Guest: LaVrene Norton, Founder Action Pact

Really – who in their work wants to be told what to do? To be handed an ‘assignment sheet’ with your tasks lifelessly written out for you? No time for thought. No time for talk about your own creative insights. There’s a better way, and it’s all about new opportunities for learning. Everyone likes to learn, and the internet has made learning more accessible now than ever before. Discovery excites us and we reach for more – through inquiry we initiate learning. We make friends with online dictionaries, Wikipedia, and Google. And who among us hasn’t used YouTube to learn how to change the oil in our car, measure for kitchen cabinets, bake yeast bread, or coach our child how to calculate the area of a trapezoid?

We relax by playing online games and puzzles that teach us to look in all the corners, watch for opportunities, and calculate dangers. As we become increasingly knowledgeable and competent, we relish working in a warm, open environment that offers online learning, nurtures self-direction and critical thinking, and rewards new skills.

RN License Renewal

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RN licenses are required to be renewed by April 26, 2019 and there is NO grace period to renew. If a license expires, the nurse will have to apply for reinstatement which includes submitting to fingerprint background checks and paying a higher fee ($110) in addition the fingerprint fees. The reinstatement process takes about two weeks.

RN’s are encouraged to renew prior to April 26, 2019.

NCSBN hosts webinars regarding the nurse licensure compact (NLC). The next two are April 9 and May 10. See this link for more details: www.ncsbn.org/nlc-meetings.htm.

CMS – Skilled Nurse Facility Quality Reporting Program Provider Training

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May 7-8, 2019: Skilled Nursing Facility Quality Reporting Program Provider Training
Location: Sheraton Kansas City Hotel at Crown Center, Kansas City

The Centers for Medicare & Medicaid Services (CMS) will be hosting a 2-day Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) in-person ‘Train the Trainer’ event for providers on May 7 and 8, 2019, at the Sheraton Kansas City Hotel at Crown Center, 2345 McGee Street, Kansas City, MO 64108. This event will be open to all SNF providers, associations, and organizations.

The primary focus of this ‘Train-the-Trainer’ event will be to provide those responsible for training staff at SNFs with information about:

  • The transition to the Patient Driven Payment Model (PDPM) which becomes effective on October 1, 2019.
  • A review of SNF QRP changes and updates to the Minimum Data Set (MDS) 3.0 Version 1.17.0, which became effective October 1, 2019.
  • An overview of the eleven SNF QRP Quality Measures.
  • An interactive session on the use of reports to identify opportunities for process improvement and utilize information contained in reports available via the Certification And Survey Provider Enhanced Reports (CASPER) system to develop quality improvement plans.

Click here to access the full agenda.

Registration for the in-person training is limited to 250 people on a first-come, first-serve basis.

For those not able to attend in person, the session will be available via webcast. A URL to access the webcast will be provided to participants closer to the training event.

QIPMO – Administrator and DON Support Group – CASPER Reports

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March 26, 2019: CASPER/Reports, DON Support Group, NHA Support Group
Location: First Christian Church, Shelbina

Stacey Bryan BSN, RN, RAC-CT, State RAI Coordinator, Section for Long Term Care Regulation, Division of Regulation and Licensure is going to go over CASPER Reports and how to use them as a tool in your home. Administrators and DONs both will benefit by learning what to do with these valuable reports.

Legionella Update

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There are numerous cases of Legionnaire’s disease reported in Missouri each year, and the frequency of those reports is increasing. The Section for Long-Term Care Regulation (SLCR) has had several resident cases of possible and confirmed legionella infections in long-term care facilities over the past couple of months. As a partner in protecting the health of the public, please read the letter from DHSS Director, Dr. Randall Williams.

CMS guidance
On June 02, 2017, CMS issued a memo titled Requirement to Reduce Legionella Risk in Healthcare Facility Water Systems to Prevent Cases and Outbreaks of Legionnaires’ Disease. www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-17-30.pdf

As part of the recertification survey process, SLCR surveyors are required to review and ask homes about their legionella risk assessment, water management programs, and testing. Specifically, surveyors will review policies, procedures, and reports documenting water management implementation results to verify that facilities:

  • Conduct a facility risk assessment to identify where Legionella and other opportunistic waterborne pathogens could grow and spread in the facility water system.
  • Implement a water management program that considers the ASHRAE industry standard and the CDC toolkit, and includes control measures such as physical controls, temperature management, disinfectant level control, visual inspections, and environmental testing for pathogens.
  • Specify testing protocols and acceptable ranges for control measures, and document the results of testing and corrective actions taken when control limits are not maintained.
  • Maintain compliance with other applicable Federal, State and local requirements.

Did you know?

  • Although most people exposed do not develop illness, approximately 25 percent of Legionnaires’ disease reported healthcare-associate cases are fatal.
  • The optimal growth temperature for Legionella bacteria is between 77 degrees and 108 degrees.  Facilities should make efforts to keep water storage and delivery vessels temperatures out of the optimal Legionella bacteria growth range.
  • Examples of building water systems that might grow and spread Legionella include: hot tubs, hot water tanks and heaters, large plumbing systems, cooling towers, and decorative fountains.

Water Management Programs
Adhering to an appropriate water management plan is critical for the successful control of Legionella bacteria in a health care setting. Developing and maintaining a water management program is a multi-step process that must be tailored specific to the facility and should be reflective of what the facility is actively doing. Below are seven steps to building an effective Legionella water management program.

  • Establish a water management program team
  • Describe the building water systems using flow diagrams and a written description
  • Identify areas where Legionella could grow and spread
  • Decide where you need to apply control measures and how to monitor them
  • Establish ways to intervene when control limits are not met
  • Make sure the program is running as designed and is effective
  • Document and communicate all activities

Source: www.cdc.gov/legionella/wmp/overview/wmp-fact-sheet.html.

The CDC’s website also provides a list of factors to consider when looking to hire a Legionella consultant: www.cdc.gov/legionella/wmp/consultant-considerations.html.

FREE Online Training
The Centers for Disease Control and Prevention recently launched a free online training program on Legionella water management programs called PreventLD. This training would be helpful for any staff member at a Long Term Care Facility who would be responsible for implementing a Water Management Plan. Details and the link to register are available here: www.cdc.gov/nceh/ehs/elearn/prevent-LD-training.html.