Please see the most frequently cited deficiencies report from the third quarter of 2023.
Missouri Long-Term Care Information Update
On September 29, 2023, you received information from the LTC List Serve regarding the Infection Prevention Toolkit that would be delivered to your facility later this month as part of the COVID Prevention and Response Project of the Missouri Department of Health and Senior Services (DHSS). DHSS has entered into an agreement with Concordance Healthcare Solutions to deliver this Infection Prevention Toolkit to your facility with costs being paid by the Nursing Home & Long-Term Care Facility Strike Team and Infrastructure Project.
Contents of this Infection Prevention Toolkit include:
Pulse Oximeter: Fingertip
Digital Non-Contact Thermometer
3M Fit Testing Kit: BITREX
3M Fit Testing Solution: Saccharin 55 mL Fluid Volume
3M Respirator Wipes: Non-Alcohol
Glo Germ Glo Box Kit with 8oz gel
For those facilities who are in need of Respiratory Fit Testing assistance please contact the Healthcare Associated Infections/Antimicrobial Resistance Program at LTCStrikeTeam@health.mo.gov.
We will be using the administrator’s name and facility address as listed on the DHSS Website https://health.mo.gov/seniors/nursinghomes/licensecert.php as well as the information for the eight hospital based skilled nursing facilities for delivery and contact purposes. Shipment of the Toolkits will begin the week of October 23, 2023.
Phase II of the COVID Prevention and Response Project will focus on working with the facilities in hopes of acquiring needed communication equipment to assist in outbreak control, training and real-time communication with healthcare providers and the Strike Team. In the coming weeks you will receive information on how to order these devices.
Please contact Mary Menges, Project Specialist, at mary.menges@health.mo.gov should you have any questions or concerns regarding with project.
November 29, 2023: Missouri Medicaid Reimbursement Update
Speakers: Camille Lockhart, Sherri Robbins and Juli Pascoe
Join LeadingAge for this webinar that will include the implementation of the MO Medicaid plan and the impact on providers, strategies on what matters now, and discuss findings in other CMI states that are calculating CMI under PDM.
CMS is requesting information regarding wireless internet access in nursing homes. If your facility does not have facility-wide wireless internet access for residents, please fill out and submit the Wi-Fi questionnaire by 12/22/23. CMS will use this information to explore the reasons and possible solutions. The questionnaire can be found at here.
Below is some key information to help long-term care facilities (LTCFs) prepare for collecting annual healthcare personnel (HCP) influenza vaccination summary data for the 2023-2024 influenza season.
Which facilities are required to report these data?
- CMS-certified skilled nursing facilities (SNFs) are required to report HCP influenza vaccination summary data through NHSN.
What data are submitted?
- The reporting period for the 2023-2024 influenza season is from October 1, 2023, through March 31, 2024. Facilities are only required to submit one report that covers the entire reporting period by May 15, 2024.
How should facilities submit these data?
- Facilities must report annual HCP influenza vaccination summary data through the NHSN Healthcare Personnel Safety (HPS) Component.
Who can activate the HPS Component?
- Only the NHSN Facility Administrator (FA) can activate a new component. The NHSN FA can then add users, including the HPS Component Primary Contact, once the component is activated.
- If the NHSN FA leaves the facility but does not transfer the role of FA to another individual prior to leaving, please complete the NHSN Facility Administrator Change Request Form: https://www.cdc.gov/nhsn/facadmin/index.html.
- Please do not de-activate any other NHSN Components, such as the LTC Facility Component.
How can LTCFs add the HPS Component?
- Instructions on how LTCFs can add the HPS Component are outlined in this document: Enrollment Level 3 Access and HPS Component Activation (cdc.gov).
Where can facilities access training materials?
- Materials pertaining to annual HCP influenza vaccination data reporting are organized under the “Annual” reporting headings on this webpage: HCP Flu Vaccination | HPS | NHSN | CDC.
What are key training materials for LTCFs?
- This slide deck reviews how LTC facilities can report annual HCP influenza vaccination data through NHSN: Healthcare Personnel Safety Component Healthcare Personnel Vaccination Module Influenza Vaccination Summary Long-Term Care Facilities (cdc.gov).
- This operational guidance document outlines the CMS reporting requirement: Operational Guidance for Skilled Nursing Facilities to Report Annual Influenza Vaccination Data to CDC’s NHSN.
Are there any upcoming trainings for LTCFs?
- Yes, there will be two refresher trainings on reporting annual HCP influenza vaccination summary data on November 21 and November 28. The content for each webinar is the same. After registering, you will receive a confirmation e-mail containing information about joining the webinar.
When: Tuesday, November 21, 2023, at 1:00 PM ET
Register in advance for this webinar: https://cdc.zoomgov.com/webinar/register/WN_PcTHDlv6SC6xyA1VYUEurQ
When: Tuesday, November 28, 2023, at 1:00 PM ET
Register in advance for this webinar: https://cdc.zoomgov.com/webinar/register/WN_lx1CWu4OSTmUDyuPgoo7AA
Who do facilities contact with questions?
- Please direct all questions regarding CMS SNF QRP requirements and deadlines to: SNFQualityQuestions@cms.hhs.gov.
- If you have any additional questions or concerns, please use NHSN-ServiceNow to submit questions to the NHSN Help Desk. The new portal can be accessed here and should be used in place of nhsn@cdc.gov. ServiceNow will help the NHSN team respond to your questions faster. Users will be authenticated using CDC’s Secure Access Management Services (SAMS), the same way you access NHSN. If you do not have a SAMS login, or are unable to access ServiceNow, you can still e-mail the NHSN Help Desk at: nhsn@cdc.gov, with “HPS Flu Summary – LTCF” in the e-mail subject line.
Thank you for your efforts reporting annual HCP influenza vaccination summary data through NHSN.
Artifacts of Culture Change 2.0
MC5 would like to thank the Section for Long-Term Care Regulation for allowing us to share the Artifacts of Culture Change at the recent provider meetings and for their continued support of our work to grow person-centered cultures in Missouri’s Senior Living Communities. It is our hope that providers will utilize the Artifacts tool to further advance resident-directed practices in their communities.
The Artifacts of Culture Change 2.0 (ACC) tool and associated supporting materials can be found at https://www.pioneernetwork.net/artifacts-culture-change/.
Watch for additional training opportunities related to implementing the Artifacts of Culture Change in future MC5 newsletters and here in the listserv.
Revitalizing MC5
MC5 is a non-profit organization whose mission is “to promote and support ongoing collaboration within the adult care continuum to create environments where the dignity and value of each individual who lives or works there is respected and celebrated”. Our mission, led by a team of passionate volunteers, is accomplished through education and networking, and provided through forums such webinars, symposiums, and at meetings held in the 13 regions located throughout Missouri.
As we plan for 2024, we would like to hear from you. What do you need from MC5, and perhaps, what talents might you be able to share with our team.
Please click here to complete a short survey.
Join members of the team from MC5 and special guests the 4th Wednesday of each month as we share stories and best practices, explore challenges faced, and together re-envision what Person-Directed Care can look like for seniors in Missouri, especially for those living and working in Missouri’s Long-Term Care and Assisted Livings communities.
October 25, 2023: Filling the Holidays with Meaning and Purpose
Special Guest: Carrie Chiusano, Executive Director for Presbyterian SeniorCare Network’s Dementia Care Center of Excellence
Conversation Starter: Come prepared to discuss best practices as well as challenges faced as you work to make the holiday season one that has meaning and purpose for the residents in your community.
Special guest, Carrie Chiusano has thirty plus years of long-term care experience with Presbyterian SeniorCare Network. Most of those years were spent helping to shape and implement the internationally renowned Woodside Place philosophy of specialty care for persons living with Alzheimer’s disease and other related dementias. Carrie is a Certified Dementia Practitioner (CDP) and a Certified Alzheimer’s Disease and Dementia Care Trainer (CADDCT) through the National Council of Certified Dementia Practitioners.
The Fall 2023 issue of The Resident Advocate is now available. This newsletter provides information on residents’ rights and care issues; news and updates on national policy; and self-advocacy tips for obtaining person-centered, quality care.
This issue includes information on:
- Tips for living with a roommate in a long-term care facility,
- Staffing issues in long-term care and how you can advocate for change,
- Steps to take when there is a problem in your nursing home,
- Reminders for visiting long-term care facilities during the holidays, and
- Participating in this year’s Residents’ Rights Month.
The Resident Advocate is a great resource to share with long-term care residents. Nursing home staff, long-term care Ombudsman programs, family members, and other advocates are encouraged to forward this newsletter to residents or print and share copies. Download this issue or past issues from the website
Long-Term Care has been among the most litigated field in the USA. This series, delivered by expert attorneys, will share experiences and best practices to incorporate into your community. The entire series or individual sessions can be purchased.
October 11, 2023: Survey Process
October 12, 2023: Staffing Agency Potholes/Temporary Staffing
November 15, 2023: Hot Survey Issues (More information soon)
November 28, 2023: Best Practices for Policies (More information soon)
October 17, 2023: A Deep Dive into Security Compliance
With continuing changes in technology innovations and the increasing number of attacks, both foreign and domestic, on information systems, it is important for senior living communities to ensure that your business partners prioritize IT security and compliance with HIPAA privacy and security requirements. Learn what your organization and your partners should be doing to protect your data, provide staff training and establish a plan for ongoing protection.
October 18, 2023: Are SNF’s a Financial Sinkhole or Golden Goose?
A high level discussion about the financial challenges of operating skilled nursing facilities and the strategies utilized to mitigate.
Learning Objectives
- Understand why the challenges in operating a SNF are real and unavoidable.
- Hear about M&A and financial metrics of SNF operators.
- Learn about the financial challenges many SNF operators are facing and strategies utilized to mitigate the impact.
- Learn the pros and cons of embarking upon the strategy of owning an ancillary business to augment profitability.
Tools of Choice is an evidence-based program focused on the implementation of universal positive practices. This two-hour introductory training is open to community members, parents, and professionals. It covers key concepts of the Tools of Choice curriculum, including: What is behavior, building positive relationships, and how to increase desirable behavior. Join the Positive Support Consultants in learning strategies to make positive change by implementing universal positive practices.
October 18, 2023 1:00 – 3:00 – Registration
October 23, 2023 10:00 – 12:00 – Registration
Presenters:
- Terri Werner, Central Area Positive Supports Consultant Lead
- Brandy Allen, Northern Area Positive Supports Consultant Lead
- Katherine Earll, Eastern Area Positive Supports Consultant Lead
- Cana Poteet, Western Area Positive Supports Consultant Lead
Target Audience:
- Anyone interested in learning more about Tools of Choice
Registration is also available on the Upcoming Webinar Webpage.
November 14, 2023: PDPM for Leaders
The Patient Driven Payment Model is the payment methodology used for traditional Medicare Part A residents, some managed care companies, and for some state Medicaid systems. This session will highlight what SNF leaders need to know and monitor for financial integrity and documentation compliance. We will discuss effective oversight of the MDS process and what data/reports exist that can be used for monitoring.
Please log into TMU and check your CNA status on the registry to ensure you are not inactive or expired.
In January 2023, the registry had 74,443 CNAs active. September 2023, the registry is showing 48,732 CNAs currently active. This shows approximately 25,000 CNA’s did not renew their certification.
Information on how to log into the registry, what documents are required to be uploaded and instructions on how to renew your CNA certification are provided in the links below.
Link to TMU: MO TMU (tmutest.com)
MO Renewal Guide – Instructions
CNA Renewal Documentation
You may call the Health Education Unit at 573-526-5686 or email us at CNARegistry@health.mo.gov for any questions.
October 10, 2023: What a Living Resident can Teach Long-Term Care Staff
Presenter: Leslie Pedtke, MHA, LNHA
In this virtual event we will be discussing ‘Through the Looking Glass’: a program developed at Aviston Countryside Manor to teach empathy to our caregivers. Staff members moved into the nursing home, lived the role of a real diagnosis, and accepted daily ‘challenges’ our residents experience every day.
From learning the importance of communication to creating meaningful engagement, the resulting insights of these caregivers sensitized other staff members – new and veteran – to practical and effective ways that they were able to immediately improve daily care for residents.
Please use NHSN-ServiceNow to submit questions to the NHSN Help Desk. The new portal can be accessed here and should be used in place of nhsn@cdc.gov, nhsntrain@cdc.gov, and nhsndua@cdc.gov. ServiceNow will help the NHSN team respond to your questions faster. Users will be authenticated using CDC’s Secure Access Management Services (SAMS), the same way you access NHSN. If you do not have a SAMS login, or are unable to access ServiceNow, you can still email the NHSN Help Desk at nhsn@cdc.gov.
Why should you use ServiceNow?
- ServiceNow has a form that guides you to provide the NHSN team with the right information so we can answer your questions faster.
- The information you provide in ServiceNow routes your questions directly to the right subject matter expert, shortening response time.
You can easily track the progress of your question and response using the ServiceNow Customer Service Portal.
**Please note:
- Currently open tickets will be addressed by the existing procedure. No new action is needed on your part.
- Tickets requiring CDA support from the NHSN CDA Team should continue to be emailed to nhsnCDA@cdc.gov until further notice.
- AUR test files for CMS Promoting Interoperability Program validation should continue to be emailed to nhsnCDA@cdc.gov until further notice.
More information on the new NHSN-ServiceNow platform can be found here. A direct link to NHSN-ServiceNow within the NHSN application will be available in October 2023.
Message from the Department of Health and Senior Services Strike Team Project
The Department of Health and Senior Services (DHSS) through the use of the Nursing Home & Long-Term Care Facility Strike Team and Infrastructure Project funds is embarking upon a multiphase project to assist in COVID prevention and response. All Missouri Skilled Nursing Facilities, Intermediate Care Facilities, Assisted Living Facilities and Residential Care Facilities will be a part of this project.
Following models from other states, Phase I of this project will be the delivery of an Infection Prevention Toolkit to all of the above mentioned facilities. This Infection Prevention Toolkit will be delivered at no cost to all of the facilities. Later this fall the Healthcare Associated Infections/Anti-microbial Resistance Program will also be sending out two infection control reference books from the Association for Professional Infection Control and Epidemiology to assist the facilities in infection prevention.
Additional information will be coming in early October on the delivery of the Infection Prevention Toolkits as well as outlining the contents of the Infection Prevention Toolkit and expected date of shipping. Again, this Infection Prevention Toolkit will be delivered to your facility at NO Cost.
The next Phase of this project will be working with the facilities in hopes of acquiring needed communication equipment to assist in outbreak control, training and real-time communication with healthcare providers and the Strike Team. Lastly, we hope to offer the facilities the opportunity to order needed infection and prevention supplies.
Thank you all for your continued efforts to care and protect the citizens of our State.
November 28-30, 2023: ALF Resident Assessment Training
Location: Courtyard by Marriott, Columbia
As required by 198.005 RSMo and 19 CSR 30-86.047, residents of Assisted Living Facilities are required to undergo a community based assessment performed by an appropriately trained and qualified individual. This individual must complete a DHSS approved 24- hour training program prior to performing resident assessments. The MALA ALF Assessment Training satisfies this regulatory requirement.
The NHSN Vaccination Team will be hosting multiple webinars to review important changes to the surveillance definition of Up to Date with COVID-19 vaccines for long-term care facilities reporting vaccination data through the NHSN Vaccination Modules.
Key Points:
- FDA approved updated 2023-2024 COVID-19 vaccines for this fall/winter season. The bivalent vaccines are no longer authorized as of 9/12/2023.
- CDC recommends everyone aged 5 years and older should get 1 dose of the 2023-2024 updated COVID-19 vaccine to protect against serious illness from COVID-19 and to remain up to date.
- Under the new recommendations, most individuals will not be up to date with COVID-19 vaccines unless they receive the 2023-2024 updated COVID-19 vaccine.
- The new definition of up to date with COVID-19 vaccines will apply for NHSN surveillance beginning the week of September 25, 2023 – October 1, 2023 (the first week of reporting Quarter 4 2023).
- The new definition applies to both the NHSN Weekly HCP and Resident Vaccination Forms and the NHSN COVID-19 Surveillance Pathways (RIFC Form).
Webinar Dates and Registration:
Topic: Up to Date Vaccination Status: Surveillance Definition Change for Long Term Care Facilities (Replay)
When: September 25, 2023, 1:00PM Eastern Time (US and Canada)
Register in advance for this webinar: https://cdc.zoomgov.com/webinar/register/WN__JGOOXuiSAW1VF2zS-_baw
Topic: Up to Date Vaccination Status: Surveillance Definition Change for Long Term Care Facilities (Replay)
When: October 2, 2023, 1:00PM Eastern Time (US and Canada)
Register in advance for this webinar: https://cdc.zoomgov.com/webinar/register/WN_TDnotOroSbiPut3-2-5RtQ
The Missouri Department of Health and Senior Services is looking to simplify your online experience. To help us evolve that experience, we need your help. We’d like to invite you to take a short survey to share your thoughts, feedback and reactions about the experiences you have had with the DHSS website.
This survey should take 10 minutes to complete and will be open through October 2, 2023.
Upon completion of this survey, you will be entered into a drawing for one of three $100 gift cards. Click here to start the survey.
We appreciate your continued partnership with DHSS and look forward to hearing from you.
Beginning September 2023, the Center of Excellence for Behavioral Health in Nursing Facilities (COE-NF) will host six (6) one-hour monthly cohort sessions. These sessions are FREE to attend! Join us for the opportunity to learn industry best practices from other nursing facilities and behavioral health subject matter experts. With the support of COE-NF behavioral health specialists, you will be able to implement the learnings in your facility.
October 19, 2023: Mental Health Basics
November 16, 2023: Screening for Mental Health & Substance Use in the Skilled Setting
December 14, 2023: Engaging with Residents: Effective Communication Skills
January 18, 2024: Incorporating BH & SUD into Individualized Assessment & Person-Centered Care
February 15, 2024: De-escalating Behavior
Please see the flyer and register here.
Following approval from the Food and Drug Administration (FDA) and a meeting among the Advisory Committee on Immunization Practices, the Centers for Disease Control and Prevention (CDC) has recommended everyone 6 months and older get an updated COVID-19 vaccine to protect against the potentially serious outcomes of COVID-19 illness this fall and winter. Updated COVID-19 vaccines from Pfizer-BioNTech and Moderna will be available in locations throughout Missouri this week.
Those who have not received a COVID-19 vaccine in the past two months can get an updated vaccine for protection this fall and winter.
“Just as in the previous years, the State of Missouri will not require anyone to be vaccinated against COVID-19; that’s not our role,” said Paula F. Nickelson, director of the Missouri Department of Health and Senior Services. “We work to ensure Missourians have access to factual information about the vaccines and access to vaccines themselves if they choose. We encourage each individual to discuss vaccination with their medical provider.”
Vaccination remains the best protection against COVID-19-related hospitalization and death, especially for individuals over age 65 or with weakened immune systems. Vaccination also reduces your chance of suffering the effects of Long COVID, which can develop during or following acute infection and last for an extended duration.
Most Missourians can still receive a COVID-19 vaccine at no cost. Most health insurance plans will cover COVID-19 vaccine at no cost to the recipient. Individuals who do not have health insurance or with health plans that do not cover the cost can get a free vaccine from local public health agencies, select Federally Qualified Health Centers and pharmacies (including Walgreens and CVS) participating in the CDC’s Bridge Access Program. Children eligible for the Vaccines for Children program also may receive the vaccine from a provider enrolled in that program.
This year marks the first fall and winter virus season where vaccines are available for the three viruses responsible for most hospitalizations – COVID-19, RSV and flu. In addition, DHSS encourages individuals to minimize virus spread by staying home when sick, practicing good handwashing and seeking testing when ill to identify the infection for better protection of one’s family, coworkers and community.
To learn more or to locate a vaccine provider, visit MOStopsCovid.com.
The NHSN Vaccination Team will be hosting multiple webinars to review important changes to the surveillance definition of Up to Date with COVID-19 vaccines for long-term care facilities reporting vaccination data and RIFC Pathway data through the NHSN Vaccination and COVID-19 Modules.
Key Points:
- FDA approved updated 2023-2024 COVID-19 vaccines for this fall/winter season. The bivalent vaccines are no longer authorized as of 9/12/2023.
- CDC recommends everyone aged 6 months and older should receive the 2023-2024 updated COVID-19 vaccine to protect against serious illness from COVID-19 and to remain up to date.
- Under the new recommendations, most individuals will not be up to date with COVID-19 vaccines until they receive the 2023-2024 updated COVID-19 vaccine.
- The new definition of up to date with COVID-19 vaccines will apply for NHSN surveillance beginning the week of September 25, 2023 – October 1, 2023 (the first week of reporting Quarter 4 2023).
- The new definition applies to both the NHSN Weekly HCP and Resident Vaccination Forms and the NHSN COVID-19 Surveillance Pathways (RIFC Form).
Webinar Dates and Registration:
Topic: Up to Date Vaccination Status: Surveillance Definition Change for Long Term Care Facilities (Initial)
When: September 18, 2023, 2:00 PM Eastern Time (US and Canada)
Register in advance for this webinar: https://cdc.zoomgov.com/webinar/register/WN_YxYp42hwT5KncquBBpLttg
Topic: Up to Date Vaccination Status: Surveillance Definition Change for Long Term Care Facilities (Replay)
When: September 22, 2023, 2:00 PM Eastern Time (US and Canada)
Register in advance for this webinar: https://cdc.zoomgov.com/webinar/register/WN_7bPDRWYETNSf6mnIo6qQvw
Topic: Up to Date Vaccination Status: Surveillance Definition Change for Long Term Care Facilities (Replay)
When: September 25, 2023, 1:00PM Eastern Time (US and Canada)
Register in advance for this webinar: https://cdc.zoomgov.com/webinar/register/WN__JGOOXuiSAW1VF2zS-_baw
Topic: Up to Date Vaccination Status: Surveillance Definition Change for Long Term Care Facilities (Replay)
When: October 2, 2023, 1:00PM Eastern Time (US and Canada)
Register in advance for this webinar: https://cdc.zoomgov.com/webinar/register/WN_TDnotOroSbiPut3-2-5RtQ
Registration Information for Upcoming Training Webinars
Please register in advance and plan to attend the initial session and/or the replay to learn more about the new updates. After registering, you will receive a confirmation email containing information about joining the webinar. The initial webinar and the webinar replays will cover the same information; therefore, you may only need to attend once but may attend more than one.
The Registration information seen above is also available on LTCF | Weekly HCP & Resident COVID-19 Vaccination |NHSN | CDC
For any questions, please send an e-mail to the NHSN Helpdesk at NHSN@cdc.gov with “COVID-19 Vaccination” in the subject line of the e-mail, along with your facility type.
As COVID case numbers are creeping up, the ICAR and QIPMO teams wanted to provide a refresher on some basic principles. Please take a moment to review our recording and slides. Feel free to reach out to either the ICAR or QIPMO team members with any questions.
Find the recording and the handouts HERE
October 10-12, 2023: Oktoberfest Long-Term Care Conference
Location: Harrah’s Casino, North Kansas City
The purpose of this intimate conference is to enable long-term care professionals to increase their knowledge and skills to better care for senior residents. Expert speakers will get you recharged while providing the latest information on hot topics in long-term care.
Please see the Oktoberfest Brochure for session details.