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Weighing Your Options: Solutions to Combat the Staffing Crisis

Nurse staffing shortages have escalated nationwide to such an extreme level they are now labeled a staffing crisis. Skilled nursing facilities have implemented wait lists, declined new admissions, and even closed units as a result of the staffing crisis.

While the nation is currently gripped by the pandemic, long-term care providers will absorb the ripple effects of the staffing crisis for years to come. Industry experts anticipate providers will see declined reimbursement, as well as increased federal auditing due to use of PHE waivers. In addition, providers should expect to see Five Star rating reductions for survey non-compliance related to infection control surveys, with zero tolerance resulting in immediate jeopardy tags. Five Star ratings for staffing may see effects from burnout, vaccine mandates and other constraints placed on healthcare workers.

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Frailty, Vulnerability and Aging

The elderly, because of reasons of pride or because of mental impairment may not always state their problem or problems directly. Tolerance and patience may be required in teasing out the issues. Often a great deal of trust must be present before a frail elder will confide in a professional who may be caring for them.

Working with this group of older individuals simply takes more time to form a strong relationship to be effective. That relationship must also include a sincere and caring attitude. The older individual in return for that care may worry and want to give “gifts” of some sort to staff and caretakers. It is their way at an attempt of feeling less dependent and an attempt to have greater control over their situation.

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Are you READY to create a happier and healthier workforce?

With Call a Doctor Plus’ exclusive programs for ACHCA administrators, you’ll create higher value for your employees by offering 24/7 access to virtual healthcare services, when and where your team needs them.

Better care for staff translates to better care for patients, and with Call a Doctor Plus’ offerings, administrators now have the key to stabilizing their workforce. With this new partnership, Call a Doctor Plus is offering two programs that ACHCA members can offer to their employees at a discounted rate:

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Top 15 Things to Know About Vaccinating Staff

COVID-19 Vaccination Federal Mandate for Staff

COVID-19 has certainly taken taking its toll on the nursing home industry where staffing was a challenge even prior to the COVID-19 pandemic. The recent directive by the federal government that is mandating that all employees of skilled nursing facilities to be COVID-19 vaccinated on or about October 18th, 2021, (the estimated last day for final COVID-19 Vaccine shot on October 4, 2021) further compounds the staffing crisis and could result in significant negative ramifications to the clinical, financial, and operational performance of nursing facilities.

This new federal mandate comes shortly after the May 11th, 2021 regulation requiring nursing homes to report weekly the status of completed COVID-19 vaccinations for both residents and staff to Centers for Disease Control and Prevention’s (CDC) National Healthcare Safety Network (NHSN).

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Belonging and Aging

In this article, I will be examining the concept of belonging, i.e. relationships with family, friends, and community as it relates to the aged individual.

There is a classic study by the researchers Lowenthal and Haven who qualify the importance of a caring relationship as a buffer against, what they declare “age-linked social losses.”

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Length of Stay (LOS) - What is the Best Calculation?

HHI is fielding many questions regarding the calculations for Length of Stay (LOS). Skilled nursing facilities across the country track the Clinically Anticipated Stay (CAS), otherwise known as Length of Stay (LOS), to determine the amount of days a patient resides in the nursing home. Data collection is the foundation for monitoring progress, but, in itself is a daunting task. CMS uses LOS in the SNF QRP program, for patients discharged to the hospital and for patients who return to the Emergency Room or hospital within 30 days of discharge from the SNF. The accuracy and consistency of these figures is critical for care, operations, outcomes and analysis.

What calculations are being used?

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Creativity and Aging

The peak years of creativity has been a subject of inquiry among many developmental psychologists. Kastenbaum, a social scientist, believes “the end of life often stimulates that creativity. It’s then when people who are about to jump into the void can sometimes be more creative and most able to transform their situation. At times like this, people can be tense, actually more alive.” Creativity can, in fact, triumph over the debilitation of an aging body as it has with many individuals.

The researcher Simonton has studied the aged and their creative genius and concludes that, “Creative productions are not necessarily tied to chronology but to successive acts of self-actualization.” A definition of self-actualization is “the full realization of one’s creative intellectual and social potential through one’s internal drive versus external drive like money, status, power” (Merriam Webster’s Dictionary).

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The Potential of Music Therapy and Aging

Music therapy is an established, evidence-based concept that promotes the health goals within a therapeutic setting. Its benefits are recorded in numerous studies that recommend a personalized approach to conditions that include autism, brain injury, Alzheimer’s, pain management and more.

Music therapy benefits people of all ages, but especially the aged individual.

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The Faculty Educator and Aging

The importance of the field of geriatric Nursing, relies on the ability of the college educator to encourage student interest in the care of the aged patient. Educational resources are readily available and can be found in professional journals, textbooks, audio-visuals, face to face seminars, webinars and approved college curriculums.

Educators depend on various teaching strategies and learning modules that benefit the learner. One particular teaching strategy has the student write a narrative that helps her explore the experiences and decisions that first led her to Nursing as a chosen profession.

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Resistance-Exercise and Aging

For the aging individual, exercise is associated with an array of benefits that support a longer life span. A recent study supports its connection to protecting and enhancing brain function. In 2016 scientists released their findings of a controlled trial study that investigated the effects of resistance training on cognitive function in older adults.

Resistance training, also called strength training, is exercise that employs weights, machines, bands or other devices that work key muscle groups. The researchers wanted to determine whether cognitive improvement occurred as a result of either increased aerobic capacity or increased muscle strengthening.

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4 Ways Your Therapy Operation Could Help You Mitigate Medicare Cuts in 2021

In early December, Centers for Medicare & Medicaid Services (CMS) finalized the Medicare Physician Fee Schedule for 2021, reflecting significant cuts to a variety of providers. Physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP) were initially going to be impacted by a reimbursement reduction of approximately 9%. In late December, in response to intense advocacy by organizations representing the 37 professions affected by the cuts, Congress approved a new omnibus and COVID-19 relief package that reduced the planned cuts to approximately 3% and put the 2% sequestration reduction on hold. The omnibus bill sets the payment rate for CY2021, but the sequestration hold expires on March 31, 2021. At that point, the 2% sequestration reduction will return for all Medicare claims. While this is certainly an improvement over the proposed 9% cut, the new cuts will still prove to be unsustainable for many providers.

So how can you mitigate these reductions in your Part B therapy billings? A key aspect of mitigating these losses is the overall management of your therapy operation. There are some obvious and some not-so-obvious areas where mitigation may be possible. In this article, we will discuss four of them: Multiple Procedure Payment Reduction (MPPR) Policy, the Medicare 8-Minute Rule, Productivity, and Staff Education.

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The Well Elderly and Aging

The emergence of a population group identified as the well elderly is the result of social and demographic progress in the industrial world. More elderly people are living longer and poverty, frailty and dependence are not necessarily the common characteristics attributed to most old people.

The future portends a healthier well elderly population who are better educated and physically as well as emotionally prepared. Society has, at present, begun utilizing their capabilities for the foreseeable future, thus guaranteeing a potentially rich human resource.

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Social Networking and Aging

A classic study by the researchers Lowenthal and Haven, demonstrated the importance of a caring relationship as a buffer against “age linked social losses”. The maintenance of a stable intimate relationship was more closely associated with good mental health and high morale than a high level of activity or elevated role status.

In other words, one appears to be able to manage stresses if relationships are close and sustaining, and if they are not, prestige and keeping busy may not always prevent depression.

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Unlocking the Nursing Component Under the Patient-Driven Payment Model

Skilled nursing facilities (SNF) began operating under the Patient-Driven Payment Model (PDPM) on October 1, 2019. Many current SNF employees have only been exposed to the Resource Utilization Group (RUG) model that was retired on September 30, 2019. The RUG model included therapy groups that ultimately trumped almost anything clinical being treated in the SNF. This may have resulted in minimum data set (MDS) assessments under the RUG model that didn’t include all diagnosis, condition, and treatment information simply because it didn’t affect reimbursement.

The MDS assessment was originally created to assist SNFs with developing a comprehensive care plan for residents admitted to a SNF. In the 1990s, the MDS also became a payment tool under the RUG payment model. Consistent focus under the RUG model was on accuracy of therapy days and minutes captured on each MDS assessment. The number of days and minutes of physical and occupational therapy and speech-language pathology services was ultimately the deciding factor regarding RUG group and daily payment amount.

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Your Data is Key: Why Analyzing Facility QRP Practices is Essential

Do you know how your community views you? Beginning in October 2020, certain Quality Reporting Programs (QRP) measures are being publicly reported on Medicare’s Nursing Home Compare site. How do you compare to your competitors in these QRP measures? Continual review, analysis and adjustment of your practices is the key to depicting the stellar services you provide.

Newly publicized QRP measures include:

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CMS Releases 2021 Medicare Part A & Part B Rates Impacting SNFs

Important information for Skilled Nursing Facility Admissions, Billers and Finance Departments! New Medicare Part A and Part B Deductibles and Premiums have been released for the 2021 calendar year. Effective January 1, 2021; the following rates will apply:

Medicare Part A SNF Coinsurance   $185.50/day (Beneficiary to pay $185.50/day after day 20 until end of Medicare Part A stay)
Medicare Part B Monthly Premium 

 $148.50* ($3.90 increase from 2020 rate)

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Unlocking the Speech-Language Pathology Component Under the PDPM

Skilled nursing facilities (SNF) began operating under the Patient-Driven Payment Model (PDPM) on October 1, 2019. Many current SNF employees have only been exposed to the Resource Utilization Group (RUG) model that was retired on September 30, 2019. The RUG model included therapy groups that ultimately trumped almost anything clinical being treated in the SNF. This may have resulted in minimum data set (MDS) assessments under the RUG model that didn’t include all diagnosis, condition and treatment information simply because it didn’t affect reimbursement.

The MDS assessment was originally created to assist SNFs with developing a comprehensive care plan for residents admitted to a SNF. In the 1990s, the MDS also became a payment tool under the RUG payment model. Consistent focus under the RUG model was on accuracy of therapy days and minutes captured on each MDS assessment. The number of days and minutes of physical and occupational therapy and speech-language pathology (SLP) services was ultimately the deciding factor regarding RUG and daily payment amount.

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Unlocking the Patient-Driven Payment Model’s Nontherapy Ancillary Component

Skilled nursing facilities (SNF) began operating under the Patient-Driven Payment Model (PDPM) on October 1, 2019. Many current SNF employees have only been exposed to the Resource Utilization Group (RUG) model that was retired on September 30, 2019. The RUG model included therapy groups that ultimately trumped almost anything clinical being treated in the SNF. This may have resulted in minimum data set (MDS) assessments under the RUG model that didn’t include all diagnosis, condition, and treatment information simply because it didn’t affect reimbursement.

The MDS assessment was originally created to assist SNFs with developing a comprehensive care plan for residents admitted to a SNF. In the 1990s, the MDS also became a payment tool under the RUG payment model. Consistent focus under the RUG model was on accuracy of therapy days and minutes captured on each MDS assessment. The number of days and minutes of physical and occupational therapy and speech-language pathology services was ultimately the deciding factor regarding RUG group and daily payment amount.

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Admitted to a Nursing Facility and Aging

The early days after admission to a skilled nursing facility are often critical to the newcomer. The anxiety surrounding the older person’s separation from his home, personal possessions and the dread of what may await him, may eventually intensify.

It is this time when a facility should be expressing their concern for this individual’s state of mind and how they plan to deal with it. Without a well thought out care plan there can be an unintentional disruption to the newcomer’s previous life that may leave him no opportunity of moving forward and settling into a new environment.

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PDPM Isolation, Quarantine, Skilling, COVID-19, and ICD-10

PDPM Isolation, Quarantine, Skilling, COVID-19, and ICD-10
Top 6 Things to Know

HHI is receiving ongoing inquiries on the MDS Coding qualifiers for Isolation and Quarantine. Although it may seem simple, there is a difference between Isolation and Quarantine.

  • Isolation is for patients with symptoms and or positive tests.
  • Quarantine is for patients exposed but exhibits no symptoms.

According to the CDC, isolation is for people who are ill, while quarantine applies to people who have been in the presence of a disease but have not necessarily become sick themselves. Per the CDC,


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