The Facility Assessment required as of August 8, 2024 was at § 483.70(e) is now moved to § 483.71.

Question: Do therapists and assistants have anything to do with the facility assessment?

Answer: Yes, therapists and assistants count as services provided which are required to be part of the facility assessment. Contracted services also count towards the requirement.

Please also note the definition of direct care staff for the Minimum Staffing Rule is different than the one used for PBJ purposes.

 

Section from the CFR:

 

Additional details to enhance our understanding of the requirements:

  • Requires each LTC facility to conduct and document a facility-wide assessment to determine what resources are necessary to care for its resident population competently during both day-to-day operations and emergencies.
  • The assessment must address or include an evaluation of the resident population, the facility’s resources, and a facility-based and community-based risk assessment that utilizes the all-hazards approach.
  • Requires an Annual Update

 

Goals:

  • Advanced equitable, safe, and quality care sufficient to meet the nursing needs of all residents and greater consistency across facilities.
  • Facility assessment allows the staff to provide meaningful input regarding the facility’s operations, which has the potential to lead to a better working environment that complements retention and hiring efforts.
  • Facilities are tasked with developing their facility assessments to determine the personnel needed to meet residents’ needs.

 

Definitions of Direct Care Workers and Support Staff

At § 442.43(a)(2), for the purposes of the proposed reporting provision at § 442.43(b), we proposed to define direct care workers to include: nurses (registered nurses, licensed practical nurses, nurse practitioners, or clinical nurse specialists) who provide nursing services to Medicaid-eligible individuals receiving nursing facility and ICF/IID services; certified nurse aides who provide such services under the supervision of one of the foregoing nurse provider types; licensed physical therapists, occupational therapists, speech-language pathologists, and respiratory therapists; certified physical therapy assistants, occupational therapy assistants, speech-language therapy assistants, and respiratory therapy assistants or technicians; social workers; personal care aides; medication assistants, aides, and technicians; feeding assistants; activities staff; and other individuals who are paid to provide clinical services, behavioral supports, active treatment (as defined at § 483.440), or address activities of daily living (such as those described in § 483.24(b), which includes activities related to mobility, personal hygiene, eating, elimination, and communication), for individuals receiving Medicaid-covered nursing facility and ICF/IID services.

 

Our proposed definition of direct care worker differs from the definition of direct care staff in LTC facilities at § 483.70(q)(1), which was established for the PBJ reporting program at § 483.70(q).

Falls are a leading cause of injury among older adults, but the good news is that many falls can be prevented. By maintaining your balance and strength, you can stay safe and independent.

 

How Our STEADY Program Can Help:

Our STEADY program is a therapy-driven fall prevention initiative that offers the latest therapeutic interventions and evidence-based treatments.  This comprehensive program targets the key factors that contribute to falls.

  • Balance Training: Improve your stability and confidence.
  • Strength Building: Boost muscle strength to support your daily activities.
  • Gait Training: Learn safe walking techniques to navigate your surroundings with ease.
  • Home Safety Tips: Get personalized recommendations to make your living space safer.

 

Your Safety is Our Priority

Our dedicated therapy team specializes in fall prevention and is committed to helping you build the strength and confidence you need to stay steady on your feet. Together, we can reduce your risk of falls and improve your quality of life. If you have concerns about your balance or fear of falling, talk to your doctor about how outpatient physical, occupational, and speech therapy could benefit you.

Imagine the interdisciplinary team at a SNF preparing to capture a snapshot of a patient’s readiness to “leave the nest” of the healthcare facility to return to their home. It’s a multifaceted process, assessing everything from how smoothly they move to how adeptly they tackle daily tasks.

 

Out with the Old. In with the New.

Currently, healthcare providers and therapists, armed with tools like the Functional Independence Measure or the Barthel Index meticulously assess every aspect of a patient’s functional prowess. Can they stride down the hallway? Can they complete daily tasks such as eating and oral hygiene without breaking a sweat? These scores paint a vivid portrait of their independence and self-sufficiency.

October 2024: CMS will replace the Percentage of Residents Who Made Improvements in Function (Short Stay) measure with the new Discharge Function Score measure which was finalized in the FY2024 SNF PPS Final Rule for use in the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) and the SNF Value-Based Purchasing (VBP) program. The remaining four measures will remain frozen until January 2025 while the data for the equivalent measures are collected.

The new Discharge Function Score Measure determines how successful each SNF is at
achieving an expected level of functional ability for its patients at discharge.

 

Why Should You Care About The Discharge Function Score?

These scores aren’t just numbers in a chart; they’re the cornerstone of how CMS will determine if the patient function is progressing in a manner that is expected and will be used in the SNF Quality Reporting Program. The final Discharge Function Score for a given SNF is the proportion of that SNF’s stays where a resident’s observed discharge score meets or exceeds their expected discharge score. According to CMS, SNFs with low scores are “not producing the functional gains they could be for a larger share of their patients.”

And let’s face it, this measure’s first year in the program is 2027 which is fast approaching. The first performance period begins FY 2025 (October 1, 2025) and everyone needs to be prepared.

 

The Roles of Each Stakeholder

We have been preparing each therapist through the ongoing education of Section GG. HTS Therapists continually receive additional education, auditing, and coaching to ensure accuracy. Therapy will be coding Section GG as is the norm. However, this is a great time and opportunity to modify your systems so that a collaborative approach from all stakeholders is well-defined when coding Section GG on the MDS. Also, it is of utmost importance that facilities ensure information is being coded to the best of their ability. Otherwise, statistical imputation occurs and it could skew data to seem like the facility isn’t doing as well as it could have been if the information had been input as intended.

Therefore, when you hear about a discharge function score, remember—it’s definitely not just a number. It is the key to showing a SNF’s collaborative, interdisciplinary approach to rehabilitating a patient to their prior level of function as expected.

For additional information, view the CMS Discharge Function Score for SNFs Technical Reports: snf-discharge-function-score-technical-report-february-2023.pdf (cms.gov)

 

HTS Partners, feel free to contact me or your Regional Director for more information. As your partner in therapy, we will continue to keep you apprised of this topic along with many others.

Written by: Sheena Mattingly, M.S., CCC-SLP, RAC-CT

Staying mobile and independent is key to living a fun and active life. But as you get older or recover from injuries, it may be necessary to use a walking aid to help you stay steady and get around safely.

 

Cane: A cane is great if you need a little extra support and balance. It’s perfect if you have mild pain in one leg or hip, feel unsteady while walking, or need extra support on one side of your body after a minor injury.

  • The handle should line up with your wrist when you’re standing.
  • Hold the cane on your stronger side to help you balance better.
  • Move the cane forward at the same time as your weaker leg.

Walker: A walker gives more stability and support than a cane and is perfect if you have major balance issues, feel unsteady often or have frequent falls, or need support while recovering from surgery or an injury that affects both legs.

  • The handles should line up with your wrist when you stand straight.
  • Push the walker slightly ahead of you, then step forward with your weaker leg first, and bring your stronger leg in line.
  • Stand straight and avoid leaning too far forward or hunching over the walker.

 

How Therapy Can Help

Physical and occupational therapy can make a big difference if you’re dealing with mobility issues. Therapists work with you to improve your strength and balance, helping you to move more easily. They can also teach you how to use canes, walkers, and other aids properly, ensuring you get the most benefit from them.

One simple yet powerful way to support our health is by spending a little time in the sun. Exposure to sunlight offers a host of benefits, from enhancing your mood to strengthening your bones.

Key Health Advantages of Soaking up Some Sunshine:

  • Enhance Your Mood: Sunlight increases serotonin levels, a hormone that boosts mood and promotes a sense of well-being.
  • Better Sleep Quality: A daily dose of sunlight can help regulate our circadian rhythm, signaling to our body when to be awake and when to sleep.
  • Boost Vitamin D Levels: Sunlight helps our bodies naturally produce Vitamin D which also helps maintain healthy bones and a strong immune system.
  • Heart Health: Sunlight can help lower blood pressure by stimulating the production of nitric oxide in the blood vessels, improving blood flow, and reducing risk of hypertension.

Tips to enjoy the sunshine safely:

  • Aim for 5 to 15 minutes of sunlight exposure a few days per week
  • Apply broad-spectrum sunscreen with at least SPF 30
  • Wear protective clothing, a hat, and sunglasses
  • Stay hydrated, especially on hot and sunny days

How Can Therapy Help?
Therapy can help you safely enjoy the benefits of spending time outdoors. Physical therapy focuses on improving mobility, strength, and balance, making it easier and safer to get around. Occupational therapy offers strategies and tools to handle outdoor challenges, such as walking on uneven terrain or gardening activities. Additionally, occupational therapists may recommend assistive devices like canes, walkers, or specialized equipment to make outdoor activities more accessible.

As we age, it’s common to notice an increase in tiredness and a decrease in energy levels. While no one keeps the same high-energy levels as we did in childhood, there are ways to combat fatigue and maintain an active lifestyle as you age.

Tips to Reduce Tiredness & Boost Energy:

  Prioritize Sleep: To improve your quality of sleep, try to maintain a regular sleep schedule and a relaxing bedtime routine. Aim for seven to nine hours of uninterrupted sleep each night.

  Stay Active: Engage in regular exercise to boost energy levels and improve your mood. Whether it’s brisk walks, swimming, yoga, or strength training, the key is to find activities you enjoy and make you feel energized.

  Eat Well: Fuel your body with a balanced diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats for continued energy throughout the day.

  Stay Hydrated: Drink plenty of water throughout the day and limit caffeine and alcohol consumption, as they can disrupt sleep and lead to dehydration.

  Manage Stress: Practice stress-reduction techniques such as deep breathing, meditation, or tai chi to promote relaxation and increase energy.

If you’re experiencing persistent fatigue, it’s important to consult with your healthcare provider. They can help identify any underlying causes contributing to your tiredness and discuss the potential benefits of physical, occupational, and speech therapy. These therapies focus on strengthening exercises, pain management, energy conservation, stress management, and activity modification, helping older adults manage fatigue and maintain an active lifestyle.

Swallowing is a complex process that involves over twenty-five muscles all working together to move food from the mouth to the stomach. For many older adults, swallowing can become a challenge.

Swallowing disorders, also known as dysphagia, can greatly impact our ability to enjoy meals and stay properly hydrated. If you find eating or drinking feels hard, experience symptoms such as coughing, choking, or feeling of food being stuck – you might be dealing with dysphagia.

Here are some common signs that may indicate you have a swallowing problem:
• Frequent coughing or choking while eating or drinking
• A feeling of food or liquid getting stuck in your throat or chest
• Pain or discomfort in your throat or chest when swallowing
• Unintentional weight loss or dehydration
• Recurrent respiratory infections or chest congestion

 

How Can Speech Therapy Help?

Speech-Language Pathologists (SLP) are uniquely qualified to help people who are experiencing problems with eating and drinking. During treatment, a SLP may recommend swallowing exercises along with other strategies to help manage dysphagia. If you or a loved one experience difficulty swallowing, talk to your doctor about Speech Therapy. Early identification and treatment of swallowing problems can help prevent complications and improve your quality of life.

As we get older, our bones can weaken, which might cause osteoporosis—a condition where bones become fragile and break easily. However, osteoporosis is not an inevitable part of aging. By learning more about it and taking action early, you can significantly reduce your risk of osteoporosis and keep your bones strong and healthy.

Did you know?
Osteoporosis is often referred to as a “silent disease” because it progresses without symptoms until a fracture occurs.

 

Prevention Tips:

Preventing osteoporosis is crucial because it is easier to maintain bone density than to rebuild it once it’s lost.

  • Get enough calcium and vitamin D from food or supplements.
  • Do weight-bearing exercises like walking, jogging, dancing, and strength training to strengthen bones.
  • Avoid smoking and limit alcohol consumption.
  • Prevent falls by keeping your home safe, improving balance, and wearing proper shoes.
  • Talk to your healthcare provider about bone density testing and, if necessary, medications to help prevent or treat osteoporosis.

 

How Therapy Can Help
Physical and occupational therapy can help individuals improve their bone health by focusing on improving bone strength, reducing the risk of falls and fractures, enhancing functional abilities and promoting safety and independence.

Now available! New Provider Data Catalog makes it easier to search and download publicly reported data. Also, Medicare’s Compare sites have been improved.

Notice of Upcoming SNF QRP Measure Removals – January 2024

The Centers for Medicare & Medicaid Services (CMS) is alerting Skilled Nursing Facility (SNF) providers of upcoming measure removals from the SNF Quality Reporting Program (QRP). The following quality measures are planned for removal from the iQIES Review and Correct Reports, Facility-Level Quality Measure (QM) Reports, and Resident-Level QM Reports in January 2024:

  • Application of Percent of Long-Term Care Hospital (LTCH) Patients with an Admission and Discharge Functional Assessment and a Care Plan That Addresses Function
  • Application of IRF Functional Outcome Measure: Change in Self-Care Score for Medical Rehabilitation Patients
  • Application of IRF Functional Outcome Measure: Change in Mobility Score for Medical Rehabilitation Patients

Once removed from reports, users will no longer have access to any data or measure results for these measures.

Click here to read more.

The Opportunity:  Medicaid is a major source of funding for many nursing homes. CMI analysis is crucial for understanding how the acuity and needs of a beneficiary affects reimbursement. A higher CMI directly correlates with increased Medicaid payments which covers the cost of patient care.

Changes on the Horizon: States have an additional two years after October 1, 2023, to implement PDPM methodology. This implies that Medicaid will no longer recognize RUG-III or RUG-IV for federal assessments after PDPM adoption.

Here is what we know so far:

  • Effective July 1, 2024, Kentucky will implement PDPM methodology for Medicaid.
    • Rates effective 1/1/2024 are calculated using RUGs. Rates effective 4/1/2024 will be frozen at the prior quarter’s rates (those effective 1/1/2024). Beginning 7/1/2024, rates will be calculated using PDPM. Rebasing provider rates is also being considered. Additional calculation details to be released.
  • Ohio will continue to determine direct care rates using RUG-IV for this biennium.
    • Effective 10/1/2023, RUGs case mix scores could only be calculated from the Optional State Assessments (OSA). After 10/1/2023, providers were allowed to freeze their case mix for the biennium, thereby eliminated the need for OSAs.
    • No additional information is available for Indiana or Michigan at this time.

Current Methodology:  By benchmarking facility data compared to state and national averages and breaking down report components, we as a team can better assess how we measure up in terms of resident acuity and case-mix. This information guides quality improvement initiatives in a targeted manner.