News / Blog
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Ask Proactive – Patient was admitted with a stage IV pressure ulcer that healed (fully epithelialized) and several months later reopened at the same site. How should this pressure ulcer be staged when it reopens?
Q: Patient was admitted with a stage IV pressure ulcer that healed (fully epithelialized) and several months later reopened at the same site. How should this pressure ulcer be staged when it reopens? A: According to the RAI Manual guidance for pressure...
Managing Long and Short Stay Pressure Ulcer/Injury Quality Measures
Pressure injuries, also known as pressure ulcers and bedsores, are a significant concern in nursing facilities, particularly among residents with limited mobility. The development of pressure injuries can be a reflection of the quality of care a resident receives,...
Ask Proactive – We have a resident on Enhanced Barrier Precautions (EBP) due to an indwelling catheter that has completed therapy and is transferring to RNP. Staff will be providing partial/moderate assistance, which will involve extended high contact, during restorative ambulation in the hallway. Therapy staff wore gowns and gloves while working with him in the therapy gym, but what should restorative nursing staff do in the hallway?
Q: We have a resident on Enhanced Barrier Precautions (EBP) due to an indwelling catheter that has completed therapy and is transferring to RNP. Staff will be providing partial/moderate assistance, which will involve extended high contact, during restorative...
Ask Proactive – How does an interdisciplinary team contribute to effective discharge planning in healthcare?
Q: How does an interdisciplinary team contribute to effective discharge planning in healthcare? A: Discharge planning is a critical process in healthcare, involving an interdisciplinary team to ensure a smooth transition from one care setting to another....
F609 Reporting of Alleged Violations: Ensuring Timely and Accurate Reporting in Long-Term Care Facilities
Reporting alleged violations promptly is crucial for maintaining safety and compliance in long-term care facilities. Among the most frequently cited issues at the Immediate Jeopardy (IJ) level are those related to Abuse and Neglect. This article focuses on F609, one...
Facility Assessment Tipsheet: Addressing Behavioral Health Needs
CMS has issued updated guidance that surveyors will use to evaluate nursing home providers’ compliance with the expanded facility assessment requirements included in the minimum staffing rule, which become effective on August 8, 2024. Every nursing home provider must...
Ask Proactive – We have a Family Council starting in our facility. What is the facility’s responsibility to facilitate a successful Family Council?
Q: We have a Family Council starting in our facility. What is the facility’s responsibility to facilitate a successful Family Council? A: Requirements for Family Councils in Medicare and Medicaid Certified Facilities Medicare and Medicaid certified...
Enhanced Barrier Precautions—Are you in compliance?
The Centers for Medicare & Medicaid Services (CMS) released QSO-24-08-NH in March 2024, the Memorandum pertaining to Enhanced Barrier Precautions (EBP) in Nursing Homes. While many facilities already had these precautions in place in some form based on CDC...
Ask Proactive – We have a resident who has a progress note documenting that resident requested HOB to be elevated because when lying down flat he can’t “catch his breath.” He doesn’t have COPD but he does have pulmonary fibrosis which is listed on his hospital H&P and receives an inhaler to help with symptom management. Is it okay to mark at I6200 on his 5-day PPS assessment?
Q: We have a resident who has a progress note documenting that resident requested HOB to be elevated because when lying down flat he can’t “catch his breath.” He doesn’t have COPD but he does have pulmonary fibrosis which is listed on his hospital H&P and receives...
Navigating Advance Directives and End-of-Life Care in Nursing Facilities
Few topics are as sensitive and crucial as end-of-life care. At the heart of this complex and emotionally charged subject are Advance Directives (ADs) – legal documents that spell out a person’s wishes regarding medical care and treatment when they can no longer...
Ask Proactive – One of our long-term residents fell and fractured their femur requiring a hip replacement. They returned to our facility on a skilled stay. The IDT met and were discussing a primary diagnosis. Therapy believes we should use Z47.1 Aftercare following joint replacement surgery but some of the available hospital documentation uses S72.141A Displaced intertrochanteric fracture of right femur, initial encounter for closed fracture. Which is the correct code?
Q: One of our long-term residents fell and fractured their femur requiring a hip replacement. They returned to our facility on a skilled stay. The IDT met and were discussing a primary diagnosis. Therapy believes we should use Z47.1 Aftercare following joint...
Ask Proactive – We have a patient who has achieved ambulation in the hallways at supervision level using a walker. Our new case manager is insistent that we discharge as soon as possible, or our services could be denied by Medicare. The patient wants to return to PLOF, independent ambulation, so her therapists do not feel a discharge is appropriate at this time. Would this claim be at risk for denial?
Q: We have a patient who has achieved ambulation in the hallways at supervision level using a walker. Our new case manager is insistent that we discharge as soon as possible, or our services could be denied by Medicare. The patient wants to return to PLOF, independent...
Avoiding the Most Commonly Cited Medication Errors
Recent CASPER data for Fiscal Year 2024 ranks deficiency F760, "Residents are Free of Significant Medication Errors," as 25th and F759, "Free of Medication Error Rate of 5% or More," as 27th. Let’s examine examples of these deficiencies along with an action plan based...
Ask Proactive – What are the best practices to prevent a deficiency, especially an Immediate Jeopardy, related to CPR?
Q: What are the best practices to prevent a deficiency, especially an Immediate Jeopardy, related to CPR? A: One of the most critical components in preventing a deficiency related to CPR is communication. The facility must ensure that the resident’s...
Minimum Staffing Rule’s Facility Assessment Mandate
On April 22, 2024, the Centers for Medicare & Medicaid Services (CMS issued the Minimum Staffing Standards for Long-Term Care (LTC) Facilities and Medicaid Institutional Payment Transparency Reporting final rule. This final rule mandates the following minimum...