Renee Kinder

Yesterday evening, one of our typical summer storms blew through Kentucky fast and furious.

Unfortunately, I was heading home at the time as street lights went blank, tree limbs of all sizes blew in the air and landed in the road, and everyone all at once forgot how to drive.

To add to the excitement when I pulled in the driveway with my youngest, the power line immediately in front of us went up popping in flames. 

As I am screaming at her to run inside, the house goes dark.

Lovely. A hot, muggy night and now no power.

We proceed to go inside and sit downstairs in the dark. I began lighting candles and screaming for everyone to gather in the den because I am at this moment convinced the roof was going to blow off, or a tree would land on the house, or something else completely catastrophic would happen.

Despite all of my encouragement for the other kids to come down, no one responds.

Then, I hear laughter. 

“Get down here NOW! There is a massive storm outside. We have no power, and you need to get down here immediately!”

Then a response, “Mommy, what are you talking about, we have power up here.”

“What? I don’t mean on your phones I mean we have no power and it’s getting dark.”

Then I hear the television.

How is this possible? 

The answer to this I still do not know. We have one half of the house without power and one half without and no internet. 

Bizarre but all the same, if I had taken a better observation of the situation, I could have realized there was no need for panic.

I see a similar theme in what likely appeared to be the overwhelming — yet we can all agree essential and needed — responses to the changes announced on June 29 related to Upcoming Guidance for Nursing Home Resident Health and Safety.

The changes include a range of updates that when approached by the entire interdisciplinary team, versus a department-specific siloed approach, can be understood and implemented in order to promote CMS’s goal of furthering support the implementation of the Long-Term Care (LTC) Facilities Requirements for Participation. 

So, what are the changes teams need to prepare for? 

Abuse and NeglectClarifies compliance, abuse reporting, including sample reporting templates, and provides examples of abuse that, because of the action itself, would be assigned to certain severity levels.
Admission, Transfer and DischargeClarifies requirements related to facility-initiated discharges.
Mental Health/Substance Use Disorder (SUD)Addresses rights and behavioral health services for individuals with mental health needs and SUDs.
Nurse Staffing (Payroll-Based Journal)Uses payroll-based staffing data to trigger deeper investigations of sufficient staffing and added examples of noncompliance.
Resident RightsImports guidance related to visitation from memos issued related to COVID-19, and makes changes for additional clarity and technical corrections.
Potential Inaccurate Diagnosis and/or AssessmentAddresses situations where practitioners or facilities may have inaccurately diagnosed/coded a resident with schizophrenia in the resident assessment instrument.
PharmacyAddresses unnecessary use of non-psychotropic drugs in addition to antipsychotics, and gradual dose reduction.
Infection ControlRequires facilities have a part-time Infection Preventionist.While the requirement is to have at least a part-time IP, the IP must meet the needs of the facility.The IP must physically work onsite and cannot be an off-site consultant or work at a separate location.The IP role is critical to mitigating infectious diseases through an effective infection prevention and control program.IP specialized Training is required and available.
ArbitrationClarifies existing requirements for compliance when arbitration agreements are used by nursing homes to settle disputes.
Psychosocial Outcome Severity GuideClarifies the application of the “reasonable person concept” and severity levels for deficiencies.
State Operations Manual Chapter 5Clarifies timeliness of state investigations, and communication to complainants to improve consistency across states.

Want to learn more?

Training Resources

On June 29, 2022, CMS provided training in the Quality, Safety, and Education Portal (QSEP) for surveyors and nursing home stakeholders to explain the updates and changes of the regulations and interpretive guidance. 

Training on the updated software will be forthcoming in QSEP in early September.

Renee Kinder, MS, CCC-SLP, RAC-CT, is Executive Vice President of Clinical Services for Broad River Rehab and a 2019 APEX Award of Excellence winner in the Writing–Regular Departments & Columns 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 Current Procedural Terminology CPT® Editorial Panel. She can be reached at [email protected] 

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.