Renee Kinder

Despite the warm temperatures here in the Bluegrass State, life has been pretty darn stormy around our house.

I shared with you all in my last blog how our home was burglarized twice. Unfortunately, the efforts of the police to locate the individuals have been unsuccessful, with many “leads,” yet no one willing to provide the officers with a name.

“Oh, yes, I know him, but …”

“And, yes, I remember that guy. I was actually in jail with him, but, sorry, don’t recall his name.”

Add to the mix of my kiddos’ angst, our 15-year-old dachshund, Hershey, passed away yesterday morning. Our other dachshund, Biddle, is refusing to eat or drink, and yesterday guarded Hershey’s body and didn’t allow anyone in the room.

So, I take it back. Life hasn’t just been stormy. It’s been more like a torrential downpour that will not stop.

But we all know the saying, that after a storm comes the … rainbow, new life, and a fresh beginning.

The kids have finally also returned home after staying for a time with friends and family.

I have learned to lock doors.

And, despite the local police being unable to locate the suspects, they have added increased patrols by our home.

Kathryn, Joseph and Lawson — posing in front of four of Louisville’s finest, who are part of the after-storm “rainbow.”

In downtown Lexington, this means our children not only receive visits from the police, they also receive visits straight to the backyard by the police horses. As you can imagine, this brings them and Mom immense joy.

We have also noticed an increased closeness among neighbors, and more folks out on porches and spending time together during cool evenings and on the weekends.

The positives around Hershey’s death are mostly impacting our other dachshund. Hershey was the oldest and set the tone in the house. She determined when everyone ate, drank, and, in recent years, whether we slept.

If Hershey wanted water at 2 a.m., she would persist until someone brought her fresh water.

None of the dogs ate until Hershey finished, and in her old age this could take up to 30 minutes while the others waited.

Biddle is not yet comfortable with her newly found freedom, but the kids are treating her like a little queen and making sure to get her extreme love and attention.

I look at this experience from our household similar to the slow-moving storm of the IMPACT Act.

Were any of you on the initial Open Door Forum when the changes were introduced?

I was, and I recall being told this would be a “marathon,” not a “sprint.”

Either way, for all of the runners out there, I am sure you attest that doing either in a light rain or even brief downpour can make the course easier and more exciting.

Now with the Requirements of Participation changes, improved survey practices, and payment reform via PDPM and PDGM, we are seeing the re-birth of best practices and increased focus on value, quality and outcomes.

We can all agree it hasn’t always been an easy road, but definitely one worth taking.

One recent update that I am particularly excited to see is regarding the updated information for proposed SPADE data and measurement of more focused clinical outcomes across the PAC spectrum.

CMS is seeking input on the importance, relevance, appropriateness, and applicability of each of the measures, standardized patient assessment data elements (SPADEs), and concepts under consideration for future years in the SNF QRP.

Areas include:

Assessment-Based Quality Measures and Measure Concepts:

Functional maintenance outcomes.

Opioid use and frequency.

Exchange of electronic health information and interoperability.


Healthcare-Associated Infections in Skilled Nursing Facility (SNF)—claims-based.

Standardized Patient Assessment Data Elements (SPADEs):

Cognitive complexity, such as executive function and memory.


Bladder and bowel continence including appliance use and episodes of incontinence.

Care preferences, advance care directives, and goals of care.

Caregiver Status.

Veteran Status.

Health disparities and risk factors, including education, sex and gender identity, and sexual orientation.

Here’s to weathering the storm together.

Thankful for clear skies here in Kentucky, a perfect day for a stroll, visiting with neighbors and celebrating the life of a much-loved dog, followed by a burial in the most precious homemade dachshund-sized casket.

Renee Kinder, MS, CCC-SLP, RAC-CT, is Director of Clinical Education for Encore Rehabilitation and is the Silver Award winner in the 2018 American Society of Business Publishing Editors competition for the Upper Midwest Region in the Service/How To Blogs category. Additionally, she serves as Gerontology Professional Development Manager for the American Speech Language Hearing Association’s (ASHA) gerontology special interest group, is a member of the University of Kentucky College of Medicine community faculty, and is an advisor to the American Medical Association’s Relative Value Update Committee (RUC) Health Care Professionals Advisory Committee (HCPAC).