It appears that Medicare/CMS is planning to start a game with our skilled therapy services. What does this mean? Basically it means that you as a person or resident will not be important, but rather you as a diagnosis will drive the care Medicare will pay for.

If you're familiar with DRGs, you will recall the uproar that happened when a patient’s diagnosis was the only driver of hospitalization, care, and payment. This is similar to that payment model.

Your fall prevention plan is executed perfectly, with exercise classes, non-slip floors, walking aids, and adequate lighting. So why aren't your fall rates where you want them?

It takes more than a safe environment and great staff to slash incident rates and avoid potential litigation. Better QA reporting and accessible, clear incident data could give you the power to prevent falls and improve the care you provide in your communities.

CFOs and caregivers can be an interesting mix—sort of like oil and water or Mars and Venus. When one talks, the other might just be hearing “Waa wa wa…” So a big ingredient of a successful team is for members with different styles to learn how to communicate effectively. Communicating effectively often means learning how to listen and translate the other party’s language. Another key ingredient to successful communication is to avoid being triggered by key words or phrases and to avoid triggering your teammates. 

How do you, the Administrator or Director of Nursing, get in the CFO’s wheelhouse? First, you have to remember that there is no one “type” of CFO. However, for the sake of simplicity, we're going to state that the CFO will be more concerned about money than anyone else in the organization, with the possible exception of the owners. 

Though any nursing job takes skill and compassion, the long-term care sector often has the most fragile patients—and therefore, one of the most challenging assignments. The nurses at ALFs, SNFs, and CCRCs in particular need to be on top of their game so they can help prevent adverse events like falls and be responsive and calm when incidents occur.

You may hire the best nurses, but this isn’t always enough for high-need populations. What can you do as an organization to help them improve the quality of their senior care each day?

You're required to keep track of adverse events in your communities, but keeping track means different things to different people. Some folks only do what they have to do to meet the minimum standard. Their teams fill out paper incident forms and place them in a file. They might even put the data into their EHR. Usually, teams compile the information periodically—most likely in an Excel spreadsheet—and share it at a quality meeting hopefully on a quarterly basis. 

Most communities hate even thinking about adverse events, but the best teams realize incident reports contain a gold mine of valuable data. QA Reader is an adverse event tracking software that turns your incident reports into an insight generator to improve QA and even help prevent incidents before they occur.

Many senior living communities find that organizational growth is both a reward and a challenge. While your hard work has enabled you to expand your services and improve your market share, you may find that keeping up with quality measures becomes more difficult. Advantage Living Centers (ALC), a 12-community organization based in Michigan, became fully aware of these challenges during a period of growth. ALC wanted to find a way to reduce incidents, improve care, and implement a consistent tracking system without losing momentum across their organization.

A study conducted by the Office of the Inspector General (OIG) from 2008-2012 identified that an estimated 22 percent of Medicare beneficiaries experienced adverse events during their SNF stays. An additional 11 percent of Medicare beneficiaries experienced temporary harm events during their SNF stays. Physician reviewers determined that 59 percent of these adverse events and temporary harm events were clearly or likely preventable. They attributed much of the preventable harm to substandard treatment, inadequate resident monitoring, and failure or delay of necessary care.

Most senior living organizations still attempt to track adverse events by keying them into Microsoft Excel spreadsheets. Tracking, managing, and reporting adverse events is mission-critical to senior living facilities and their parent organizations.

EHRs are patient-focused, while adverse event management is facility-focused. So, quality and nursing staff take matters into their own hands to handle adverse event tracking in spreadsheets. 

In a 48-week study, an open-label, flexible dose of risperidone was administered for 16 weeks to 180 patients with a diagnosis of Alzheimer’s dementia with agitation and/or aggression. The patients in the study had a mean age of 79 years at baseline. Patients were moderately impaired with a mean mini mental state exam of 14.

Per Anjali Patel, D.O., “I think the clinical impact we see here is that for patients with hallucinations and particularly auditory hallucinations, antipsychotic discontinuation should be done very, very cautiously because they do have a very high risk of relapse. Close monitoring will be necessary and antipsychotic medications promptly reinstated if relapse occurs.” The risk for relapse was particularly high when the hallucinations were primarily auditory. In fact, visual hallucinations were not predictive of relapse.

An EHR is an indispensable tool in today’s senior living communities. It provides you with a secure location to store your resident-specific data, including the recording of incidents and accidents. The paperless capability means you don’t have to worry about filing papers or losing important documents.

But recording individual incidents isn’t enough to improve quality of care and help prevent future accidents and falls. Although you’ll have the information you need on a resident’s history, this alone can’t help you improve your quality outcomes. The EHR simply isn’t designed to do this.

So how can you use the data you already have in your EHR to improve quality outcomes and financial performance?