Spring is in the air.
I feel it. I see it. It must be coming.
My 11-year-old, Joseph, said it best over the weekend … “Mommy there is something different about the smell of the air outside, it brings back memories for me, like winter will soon be over.”
We were outside this weekend for many reasons. The ice and snow were melting, we have been going stir crazy with COVID-19, but truth you all, we had a bit of disruption in the yard of the Kinder home Sunday afternoon.
It started around 3:45 p.m., I let the two “big dogs” out in the backyard, our doberman and our golden retriever, while I was doing laundry. They went bananas. Full on aggressive barking.
And then I hear voices, young voices in our yard.
I look out and it took me a moment to process, four teenage boys, unknown to me, in our yard, who had kicked down a fence and where in our backyard shed pulling out our children’s bikes. They proceeded to jump a fence and enter our neighbor’s garage.
What do I do? Those who know me. I panic and yell at them for trying to make off with my 6-year-old daughters favorite pink bike.
I have a point here. Spring is in the air, it is time to brush off the dust, the fog if you will of COVID, and move forward into a New Year, learning from each other and appreciating the struggles many have endured during this time of pandemic.
This is true for all of you hard-working caregivers in the post-acute care industry. It is also true in our communities for those who have been isolated for extended periods of time with the closure of so many schools and social supports.
Recently, I had the opportunity to present on the topic of Quality Measures and what the industry should consider leading into 2021. What I learned in development of these materials is that quality can not be a single focus. Even in the regulatory sense, it is too broad so we must learn to appreciate the simplicity of understanding what is unique to your community.
Like the lesson I learned Sunday and what is unique to my downtown community in Lexington, KY.
While I am panicking, my husband calmly eyes the boys riding off on bikes, puts on a baseball cap, and walks — not runs — walks out the front door.
Back to quality.
What, to begin, are current LTC quality reporting metrics you should consider as part of your spring cleaning?
There are many including:
- CASPER QM Reports
- Quality Measures
- Care Compare
- 5-Star Rating
- Skilled Nursing Facility Value Based Purchasing (SNF VBP)
- Skilled Nursing Facility Quality Reporting Program (SNF QRP)
- Meaningful Measures
As a bit of history, the “Meaningful Measures” framework is the Centers for Medicare & Medicaid Services’ new initiative that identifies the highest priorities for quality measurement and improvement.
- It involves only assessing those core issues that are the most critical to providing high-quality care and improving individual outcomes.
- The Meaningful Measure Areas serve as the connectors between CMS strategic goals and individual measures/initiatives that demonstrate how high-quality outcomes for our beneficiaries are being achieved.
- They are concrete quality topics, which reflect core issues that are most vital/meaningful to high quality care and better patient outcomes.
- Meaningful Measures is not intended to replace any existing programs but will help programs identify and select individual measures.
- Meaningful Measure areas are intended to increase measure alignment across CMS programs and other public and private initiatives. Additionally, it will point to high priority areas where there may be gaps in available quality measures while helping guide CMS’s effort to develop and implement quality measures to fill those gaps.
Strategically, as you determine this spring how to focus on your community, we need to realize what you can accomplish and what systems are in place to measure success. How are you assessing trends, integrating care, implementing with an IDT approach, and measuring from a QAPI perspective.
There is never a one size fits all answer. Each individual community will be different.
Consider the model below:
Consider that the root cause for weight loss noted on your long stay quality measure may be limited community dining, poor positioning during meals and reduced sensory environment. Strategic clinical programs could include: walk to dine; integrating more natural setting in the dining environment, and improved lighting and contrast.
Additionally, root cause analysis for fall with major injury could be: reduced opportunity for out-of-bed movement, physical barriers in room environment, and an ineffective toileting program. Strategic clinical programs to resolve could include walk to dine (as allowed), planned out-of-bed activities, and a strategic toileting program.
For root cause, remember to ask the “5 ways” when assessing the trends in your community.
The same is true with the apparent destruction in our yard Sunday.
Not only did my husband know the young men who broke down our fence from playing in pick-up games at our downtown basketball courts, he found them, called them by name, and within 30 minutes had them back at our house with a hammer and nails in-hand repairing the fence and apologizing for their actions.
These were children that he had given basketballs to when he noticed they never played alone due to not having any. He had taken them refreshments and Gatorade after playing because they had none.
Most importantly, he met them where they were, in that moment, and did not get upset. He saw the opportunity to teach them a lesson.
I learned much that day about meeting people where they are. It is time now to meet those we serve where they are.
The last year has been rough. We have kept our patient population safe, but now is the time to recognize the potential declines, which have occurred during this time of isolation necessitated for safety.
Spring is in the air. I can smell it, I can feel it, and I can not wait to see what the year ahead holds.
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 Relative Value Update Committee (RUC) Health Care Professionals Advisory Committee (HCPAC).