Are you a new MDS Coordinator? Are you unsure where to begin? Print and save the helpful tips below from the Section for Long-Term Care Regulation:
Category: SLCR Guidance
New Generations Quarterly Newsletter – Spring 2014
The Section for Long-Term Care Regulation has published New Generations – Volume 12, Issue 2, Spring 2014.
A complimentary color copy will be distributed via regular mail to each licensed home in Missouri. The spring issue is now available on the Department’s website, along with an archive of previous issues. Please visit http://health.mo.gov/seniors/nursinghomes/providerinfo.php.
MC5 Regional Meetings – May / June 2014
Please visit the Missouri Coalition Celebrating Care Continuum Change (MC5) website at www.momc5.com/regional-meetings.html, or click on the regional area links below.
MAY
May 7, 2014: Southwest
Webinar #3: Security is More Than an Alarm System
MC5 and Primaris Learning Collaborative
Location: The Library Center, 4653 S. Campbell Ave., Springfield, Mo.
May 9, 2014: East
Through the Looking Glass
Location: Brentwood Community Center, 2505 S. Brentwood Blvd., Brentwood, Mo.
May 20, 2014: East Central
MDS & QAPI
MC5 and Primaris Learning Collaborative
Location: The Centre, 1200 Holloway Rd., Rolla, Mo.
May 21, 2014: Northwest
Phishing for Memories: Helping Reel in the Catch!
Location: East Hills Library, 502 N. Woodbine Rd., St. Joseph, Mo.
May 23, 2014: Poplar Bluff
Person Centered Care in Activities
Location: DHSS, 2875 James Blvd., Poplar Bluff, Mo.
JUNE
CENTRAL – Columbia
June 3, 2014: De Minner will not be able to present “Dementia Care Mapping” on June 3. Culture Change for Surveyors will be presented by DHSS State Culture Change Coordinator Sam Plaster.
Not only is Culture Change the right thing to do, it is required by regulations. Come learn how State long-term care surveyors are taught to apply Culture Change concepts to the regulatory process.
FREE Administrator (2A) and Social Worker CEUs available!
Location: The Neighborhoods by Tiger Place, Community Room, 3003 Falling Leaf Court, Columbia, Missouri. There is no charge to attend, but registration in advance would be appreciated. RSVP to Beth at bbusseau@cmaaa.net or 573-443-5823.
SOUTHEAST – Cape Girardeau
June 6, 2014: Developing Foundational Tools for Change: A Discussion of four Organizational Practices, presented by Julie Ballard, R.N., Director of Culture Change, Health Systems Inc.
This session will focus on lessons learned from the Pioneer Network Learning Collaborative which MC5 participated in over 2012-2013. Many useful tools were created from this Collaborative and are now part of the “Pioneer Network Starter Toolkit: Engaging Staff in Individualized Care.” The four foundational organizational practices of dedicated assignment, huddles, CNAs in care planning, and quality improvement closest to the resident will be highlighted.
FREE Administrator and Social Worker CEUs Available!
Location: Cape Girardeau Public Library, 711 North Clark St., Cape Girardeau, Missouri. RSVP to John Langley at cypress@americareusa.net.
NORTH CENTRAL – Chillicothe
June 12, 2014: Staff Retention and Stability
Presented by Primaris Program Manager Kent McGeeney, LNHA, MPA, MSE.
EAST CENTRAL – Rolla
June 17, 2014: MC5 and Primaris Learning Collaborative – It Takes a Team to Provide High Quality Individualized Care
Utilizing the Pioneer Network National Learning Collaborative Webinar Series on Using MDS 3.0 as an Engine for High Quality Individualized Care. Monthly meetings will be facilitated by Primaris Program Manager Nursing Home Services Alexis Roam, MSN, RN.
Most Frequently Cited Deficiencies Report – First Quarter 2014
Please view the quarterly report from the Section for Long-Term Care Regulation here: Most Frequently Cited Deficiencies Report First Quarter 2014.
New High School Equivalency is Acceptable Prerequisite to Enroll in CMT Training Programs
January 1, 2014 was the deadline for passing the GED® High School Equivalency (HSE) exam. The Missouri Department of Elementary and Secondary Education has replaced the GED® with a new HSE exam, the HiSET™. To learn more about the new exam, please visit http://dese.mo.gov/alrs/hse/.
Regulation 19 CSR 30-84.020 Certified Medication Technician Training Program (6) (A) 1., indicates that a high school diploma or General Education Development (GED) Certificate is required to be eligible to enroll in the course. Since the HiSET™ exam has replaced the GED® exam in Missouri, passing the HiSET™ exam is also acceptable.
If you have any questions, please contact the Section for Long-Term Care Regulation, Health Education Unit at 573-526-5686.
End-of-Life Care Manual: Online Questionnaire
A committee has formed to revise and improve the manual titled “Guidelines for End-of-Life Care in Long-Term Care Facilities.” The current manual is available at http://health.mo.gov/seniors/nursinghomes/lawsregs.php.
The committee values your input! Would you help to improve this manual by taking a minute to complete a short online questionnaire? Please visit www.surveymonkey.com/s/MOEOLC.
If you have any questions, please contact Rita Summers, Missouri Long-Term Care Ombudsman Program, at rita.summers@health.mo.gov or 573-751-6335.
Cardiopulmonary Resuscitation (CPR) in Nursing Homes – Guidance Clarification Update
Guidance Clarification Update February 21, 2014
The Section for Long-Term Care Regulation (SLCR) wants to make certified providers aware that updated guidance from CMS (S&C: 14-01-NH) now requires “certification” of some nursing home staff as part of the nursing home’s compliance with regard to CPR. Previously, if a question arose during a federal regulatory process regarding whether someone could perform CPR properly, a surveyor may have needed to ask for an explanation of appropriate technique from some available staff member to verify compliance with that requirement, but verifying the certification of a particular staff member typically was not necessary.
This most recent memo states that “certification” of some staff members is mandatory, but the memo does not clarify which certifying agencies are acceptable (i.e., American Heart Association). SLCR and the Kansas City Regional CMS office requested a clarification of this point.
We have now received guidance indicating that the purpose of this memo was to, “…ensure that facilities do not implement facility-wide ‘no CPR’ policies and that facilities have CPR-certified staff available at all times,” but that CMS does not intend to review or approve all certification agencies.
A wide range of organizations offer CPR certification – some are based online and some are conducted in-person. To this point, CMS has clarified that while S&C: 14-01-NH does not require the use of any specific certifying agency, there are two components that are required with regard to CPR certification:
- The certification must be designed for healthcare providers (therefore, CPR courses for laypersons which teach chest compressions, but not mouth breathing, are not sufficient); and
- Nursing home policies should address how staff members should maintain and document their CPR certification.
The American Heart Association certification is acceptable under this guidance, but it is not the only acceptable certification. Many homes in Missouri are currently obtaining CPR certification through the American Safety & Health Institute (ASHI), which is also acceptable, as are others, as long as they are designed for professional healthcare providers.
You may view the memo here: CMS Memo S&C: 14-01-NH, or visit www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions.html.
New Generations Quarterly Newsletter – Winter 2014
The Section for Long-Term Care has published New Generations – Volume 12, Issue 1, Winter 2014. This issue is now available on our website, along with an archive of previous newsletters. Please visit http://health.mo.gov/seniors/nursinghomes/providerinfo.php.
Most Frequently Cited Deficiencies Report – Fourth Quarter 2013
Please view the quarterly report from the Section for Long-Term Care Regulation here: Most Frequently Cited Deficiencies Fourth Quarter 2013
MDS and Flu Season
CMS posts the public Quality Measures on Nursing Home Compare, and consumers are able to view the percentage data that your nursing home offered and administered the flu vaccine during the current or most recent influenza season.
The 3.0 Resident Assessment Instrument (RAI) manual does not provide specific dates for influenza season. This has prompted Missouri facilities to ask what dates are considered the influenza season in Missouri, in order to correctly code the MDS, which will be reflected in their Quality Measures. Seasonal flu monitoring and reporting to the CDC in Missouri begins in early October and extends well in to the month of May.
For MDS coding purposes, if the resident is not in the facility between October 1 and May 31, you should code in Section O: “Resident not in facility during this year’s flu season.” For residents who are in the facility from October 1 through the last week of May, the facility is required to offer the flu vaccine as long as it is “reasonably available,” which means that it is still available to be ordered from your local pharmacy or supplier.
If you have any questions, you may contact Joan Brundick, State RAI Coordinator, at 573-751-6308 or email joan.brundick@health.mo.gov.
Health Advisory: pH1N1 Influenza
Health Advisory: Pandemic pH1N1 Virus-Associated Illnesses and the Influenza Season in Missouri (12.26.13)
CDC Health Advisory: Notice to Clinicians: Early Reports of pH1N1-Associated Illnesses for the 2013-14 Influenza Season (12.24.13)
Health Alerts, Advisories, and Updates are available on the Department of Health and Senior Services website. For the most current information, please visit: http://health.mo.gov/emergencies/ert/alertsadvisories/index.php.
Flu Season is Here
Homes are required to offer the flu vaccine to all of their residents. Vaccination of your healthcare workers, although not mandated, is also important in preventing the spread of flu in your home. Encouraging your staff to receive the vaccination can also help reduce absenteeism due to illness and reduce the costs of care associated with ill residents.
Flu season information is available on the CDC website at www.cdc.gov/flu/index.htm.
Safety Reminders: Holiday Decorations
It is that time of year when people are decorating their homes and businesses with festive décor and anticipating upcoming holiday celebrations. Residents and staff in your care home also look forward to festivities and enjoy holiday decorations. It is important for residents, staff and visitors to carry on traditions and to feel a sense of joy and peace we all want this time of year.
The Section for Long-Term Care Regulation (SLCR) wants to help you and your residents have a safe holiday season by sending out the following safety tips, references and regulatory reminders.
Fires or other accidents are not something anyone wants!
Safe decorations include:
- Artificial Christmas trees, and decorations that are non-combustible or flame retardant.
- UL approved decorative lighting (use in supervised areas and turn off when not in use).
- UL approved outdoor lighting.
- Holiday decorations, including evergreen wreaths, ornaments, photos, etc. can be used on resident’s doors, and in hallways, as long as they do not exceed 3 ½” in depth and they are not blocking the entrances or exits.*
*Any combustible decorations hung from doors or walls in corridors may be used with a waiver. Non-rated combustible decorations cannot exceed 20% of the wall space in an exit egress corridor.
SLCR published an article regarding holiday decorating in the winter 2011 edition of the quarterly newsletter. Please visit http://health.mo.gov/seniors/nursinghomes/providerinfo.php.
Although the 2000 Edition National Fire Protection Association (NFPA) 101® Life Safety Code (LSC) is the official reference, the 2012 Edition contains some less restrictive requirements. Please refer to the CMS memo regarding waivers here: CMS Memo S&C 13-58-LSC 2000 Edition National Fire Protection Association (NFPA) 101® Life Safety Code (LSC) Waivers, or visit the CMS website at www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions.html.
Prohibited decorations include displays, hangings, and other decorations that block exits, visibility of exits, or fire protection appliances. Never hang decorations from fire sprinkler heads or pipes.
NFPA 101, Section 19.7.5.4: Combustible decorations shall be prohibited in any health care occupancy unless they are flame retardant.
NFPA 101, Section 7.1.10.1: Means of egress shall be continuously maintained free of all obstructions or impediments to full instant use in the case of fire or other emergency.
NFPA 101, Section 7.1.10.2.1: No furnishings, decorations, or other objects shall obstruct exits, access thereto, egress therefrom, or visibility thereof.
Please note, some county or city local ordinances may also require compliance with more restrictive standards, including the International Fire Code (IFC).
- F323: Electrical Safety – Any electrical device, whether or not it needs to be plugged into an electric outlet, can become hazardous to the residents through improper use or improper maintenance. Electrical equipment such as electrical cords can become tripping hazards. Halogen lamps or heat lamps can cause burns or fires if not properly installed away from combustibles in the resident environment. The Life Safety Code prohibits the use of portable electrical space heaters in resident areas.
- Extension cords may be used on a TEMPORARY basis. For information regarding the use of extension cords, please visit the SLCR website at http://health.mo.gov/safety/ltcqa/questionsandanswers.php#no13.
- Can candles be used in nursing homes under supervision, in sprinklered facilities?
CMS Memo S&C-07-07: Nursing Home Culture Change Regulatory Compliance Questions and Answers
Answer: Regarding the request to use candles in sprinklered facilities under staff supervision, National Fire Protection Association data shows candles to be the number one cause of fires in dwellings. Candles cannot be used in resident rooms, but may be used in other locations where they are placed in a substantial candle holder and supervised at all times while they are lighted. Lighted candles are not to be handled by residents due to the risk of fire and burns.
This holiday season, consider using battery-operated flameless candles. They look and smell real! Learn more about candle fire safety from the U.S. Fire Administration at www.usfa.fema.gov/citizens/home_fire_prev/holiday-seasonal/holiday.shtm.
If you have any questions regarding the Life Safety Code, please contact SLCR at 573-526-8524. We wish you a wonderful and safe holiday season.
Tuberculin Skin Test Antigen Available – Shortage Resolved
The national shortage of TUBERSOL® used in the administration of PPD tuberculin skin tests appears to be resolved and is now widely available. Providers should administer PPD tuberculin skin tests that were deferred due to the shortage. Please make every effort to complete all deferred testing within the next 30 days. If you are unable to meet this timeframe, please work with your Regional Office to establish an acceptable timeframe to complete your deferred testing. If you have any questions, you may also contact Joan Brundick at 573-751-6308 or send an email to joan.brundick@health.mo.gov.
posted December 6, 2013
RAI Process & Medicare from Start to Finish 2014 Workshops
July 8 – 9, October 7 – 8, 2014: RAI Process from Start to Finish
April 25, August 12, November 12, 2014: Medicare from Start to Finish
Location: Courtyard by Marriott in Columbia, Missouri. View the brochure here: RAI – Medicare from Start to Finish Workshops Updated Brochure 2014 or visit www.mlnmonursing.org/MDS.
The Missouri Coalition Celebrating Care Continuum Change
The Missouri Coalition Celebrating Care Continuum Change (MC5)
by Sam Plaster, State Culture Change Coordinator
The Patient Protection and Affordable Care Act passed by Congress in 2010 requires that all nursing homes develop Quality Assurance and Performance Improvement (QAPI) programs, ensuring that homes continuously identify and correct quality deficiencies as well as sustain performance improvement. While the Center for Medicare & Medicaid Services (CMS) has yet to promulgate the specific regulatory requirements, many homes are already initiating or improving their QAPI processes… to read more and view photos click here: MC5
Cardiopulmonary Resuscitation (CPR) in Nursing Homes
CMS Memo S&C: 14-01-NH
The Section for Long-Term Care Regulation wants to make certified providers aware that this Memo requires “certification” of some nursing home staff as part of the nursing home’s compliance with regard to CPR. CMS’ guidance had previously been that an on-duty staff member be able to perform CPR appropriately at all times. If a question arose during a federal process regarding whether someone could perform CPR properly, a surveyor may have needed to ask for an explanation of appropriate technique from some available staff member to verify compliance with that requirement, but verifying the certification of a particular staff member typically wasn’t necessary.
One point that remains unaddressed in this new S&C Memo is that many different CPR training agencies offer “certification” of their own, and this Memo doesn’t specify which agency’s certifications are acceptable to CMS and which are not. SLCR has requested a clarification of this point from the CMS Central Office, and so has the Kansas City Regional CMS office. Neither of our offices have received a response. When we receive further guidance, we will provide it to you via this Listserv. Until then, we will not be altering our current survey practices, but we want to make providers aware that this new S&C Memo has been issued by CMS, and that depending on their answer to our questions, it’s likely that some of your staff may need to obtain CPR certification with very short notice.
Because this memo references the American Heart Association as a standard-setting organization with regard to CPR, it is our belief that provider certification through the AHA will almost certainly be deemed acceptable by CMS. Whether other certifications will suffice is less clear at this time. As soon as we have some clarification on this point, we will share it with you. We apologize that we can’t offer more specific guidance at this time, and appreciate your patience.
View the CMS Memo S&C: 14-01-NH here: Survey-and-Cert-Letter-14-01 or click here.
UPDATED GUIDANCE HAS BEEN POSTED – PLEASE REFER TO:
https://wp2.mo.gov/health-ltc/2014/02/24/cardiopulmonary-resuscitation-cpr-in-nursing-homes-guidance-clarification-update/
New Generations – Autumn 2013 Quarterly Newsletter
The Section for Long-Term Care has published New Generations – Volume 11, Issue 4, Autumn 2013. This issue is now available on our website, along with an archive of previous newsletters. Please visit http://health.mo.gov/seniors/nursinghomes/providerinfo.php.
Most Frequently Cited Deficiencies Report – Third Quarter 2013
Please find the quarterly report here: Most Frequently Cited Deficiencies – Third Quarter 2013 from the Section for Long-Term Care Regulation.
Regulation Update Notice
The revision to regulation 19 CSR 30-82.070 Alzheimer’s Demonstration Projects (Rescinded September 30, 2013) has been published in the Code of State Regulations. The official new rule can be found on the Missouri Secretary of State’s website at: http://www.sos.mo.gov/adrules/csr/current/19csr/19csr.asp. The rule is located under Division 30 in Chapter 82. The effective date for the new rule is September 30, 2013. If you have any questions regarding implementation of the rules, please contact the Section for Long-Term Care Regulation, Policy Unit Manager Carmen Grover-Slattery, at 573-526-8570.
Resident Assessment Instrument and Medicare Workshops
October 8 – 9, 2013: RAI Process from Start to Finish
This workshop is for individuals in long-term care who coordinate and/or code the MDS and need a better understanding of the complexity of the RAI process. New MDS Coordinators and those who need a refresher are strongly encouraged to attend.
NEW – November 12, 2013: Medicare from Start to Finish
This workshop will help the MDS coordinator and other members of the interdisciplinary team to understand the admitting criteria and the ongoing documentation needs of the Medicare resident.
Please view the informative brochure here: RAI and Medicare from Start to Finish Workshops, or visit www.mlnmonursing.org/MDS.
Minimum Data Set (MDS) 3.0 Discharge Assessments – Not Completed and/or Submitted
Completing MDS 3.0 discharge assessments has been a requirement since October 1, 2010. However, many homes are not completing these assessments.
The Centers for Medicare & Medicaid Services (CMS) issued a Survey and Certification memorandum on August 23, 2013, which clarifies the assessments are required. The memo helps surveyors understand what nursing homes should do when they have inactive residents on their resident roster, and how nursing homes can ensure compliance with these requirements.
CMS is providing an opportunity to rectify the current situation related to missing and incomplete discharge assessments. Homes must complete missing discharge assessments as soon as possible, but no later than September 30, 2013. Homes can self-audit their MDS assessments by accessing the CASPER system and requesting a MDS 3.0 Resident Roster or a MDS 3.0 Missing Assessment Report.
If you need assistance accessing or interpreting these reports, please contact the State MDS Unit at 573-751-6308, joan.brundick@health.mo.gov or 573-522-8421, denise.mueller@health.mo.gov.
Please review the CMS Memo – Ref: S&C: 13-56-NH online at www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter-13-56.html.
Most Frequently Cited Deficiencies Report – Second Quarter 2013
View the quarterly report from the Section for Long-Term Care here: Most Frequently Cited Deficiencies April 1 – June 30, 2013
New Generations – Summer 2013 Quarterly Newsletter
The Section for Long-Term Care has published New Generations – Volume 11, Issue 3, Summer 2013. This issue is now available on our website, along with an archive of previous newsletters. Please visit http://health.mo.gov/seniors/nursinghomes/providerinfo.php.
MC5 Regional Meetings – July 2013
East – July 12, 2013: Is our Iceberg Melting too? An Expedition Toward Consistent Assignment
Brentwood Community Center, Room 104, 2505 S. Brentwood Blvd., Brentwood. RSVP to Ruthie, rrochman@alz.org or 314-801-0446.
Southwest – July 16, 2013: Food and Dining – Dining with Friends
Council of Churches, 627 N. Glenstone, Springfield. RSVP to cindybutler@mchsi.com.
Northwest – July 17, 2013: Life Safety Code and Culture Change
East Hills Library, 502 N. Woodbine Rd., St. Joseph. RSVP to Karen Fletchall, wccc.karen@yahoo.com, 660-564-3304, or Freda Miller, fmiller@nwmoaaa.org, 660-822-6209.
Route 71 – July 19, 2013: Interact III
Community Center, 200 N. Ash, Nevada. RSVP to sghouser@medicalodges.com.
West – July 24, 2013: Staff Turnover and Open Forum with DHSS
St. Mary’s Manor, 111 Mock Ave., Blue Springs. RSVP to Kathy Vogt or Leslie Carter at 816-228-5655.
Please visit the Missouri Coalition Celebrating Care Continuum Change (MC5) website for details!