Joseph Scopelliti was admitted to Laurel Brook after being diagnosed with COVID-19 at the hospital. Prior to his hospitalization, Joe was independent and living at home. Following his fight against COVID-19 he was debilitated and on oxygen.
Joe’s PT and OT created patient centered plans of care to address functional mobility, ADLs, endurance and strategies to combat shortness of breath. He worked hard to get back to his prior level. In fact, Joe was such a hard worker that he motivated other residents at the facility including his own roommate. The therapists report when they knocked on the door, Joe was ready to go. Despite having in-room treatments, Joe and the therapy crew used objects in his room to simulate his home environment to prepare him for a safe discharge.
Upon discharge, Joe was successfully weaned off his supplemental oxygen and was able to walk out of the SNF independently without an assistive device! He did an amazing job in a short amount of time and was able to return home completely independent. We are really proud of Joe and hope that he continues to succeed at home!
During times of pandemic and national emergency, when flexibilities or waivers are allowed by CMS, supportive documentation is crucial to justify the need for our skilled care. Throughout the public health emergency, many providers have utilized the available waivers for SNFs, including “skilling in place.” With use of these waivers the following should be considered:
Physician involvement, skilled nursing notes, and therapy evaluations and treatments should demonstrate medical necessity and skilled interventions relative to specific patient care needs.
A signed physician certification will not suffice; the documentation needs to clearly support the order.
The patient assessment, physician documentation, justification for the reason why the patient should be skilled in place versus discharged to the hospital, and hospital notes that document rationale for not admitting a patient or discharging early should all be obtained and recorded.
Consistent and thorough documentation related to the care being delivered and why the particular care being provided is appropriate to the patient’s diagnosis, illness, or condition should be included.
Strong facility processes, ongoing communication, and frequent medical record spot checks are the most effective ways to ensure that your records can best support the patient-centered care that is provided through the health care emergency and beyond.
After the emergency declaration is rescinded, it is very likely that CMS, either through the Office of the Inspector General (OIG) or contractors, will look to ensure that Medicare dollars were spent appropriately without fraud, waste or abuse. When evaluating the use of the waivers, it is important to focus on CMS’ goal to take “aggressive actions and exercise regulatory flexibilities to help healthcare providers contain the spread of 2019 Novel Coronavirus Disease (COVID-19).” Documentation will be critical to explain the rationale for the use of the waivers as well as clinical decision making for application.
In conclusion, a thorough interdisciplinary treatment record is crucial to support the specialized services provided during this health care emergency. As we continue to provide excellent resident-centered care, we should ensure that we demonstrate the complexity, sophistication, and medical necessity of the services that we provide in our documentation. Documentation is paramount to fortify defensibility following this pandemic and to ensure our residents continue to have access to quality care.
CMS released a memorandum addressing COVID-19 survey activities, enhanced enforcement, and engagement of Quality Improvement Organizations (QIOs). CMS also released a state-by-state report on COVID-19 cases for residents and staff along with numbers of infection control focused surveys completed. The memorandum includes guidance related to
Focused Infection Control Nursing Home Surveys and CARES Act Supplemental Funding
States that have not completed focused infection control surveys in 100% of their state’s nursing homes by July 31, 2020 will be required to submit a corrective action plan outlining the strategy for completion of these surveys within 30 days.
Access to CARES Act allocations will be impacted by state performance on completing the nursing home infection control focused surveys.
COVID-19 Survey Activities
Requiring states to implement the following COVID-19 survey activities. States that fail to perform these survey activities timely and completely could forfeit up to 5% of their CARES Act allocation, annually.
Expanded Survey Activities
Emphasizes Nursing Homes Re-opening Recommendations, which indicates that once a state has entered Phase 3 of the reopening process, states may use their discretion as to whether and how they decide to expand survey activity beyond the current survey prioritization.
Enhanced Enforcement for Infection Control Deficiencies
For all infection control deficiencies at a scope and severity of D or above, CMS will impose a directed plan of correction that will include the use of root cause analysis.
Support From Quality Improvement Organizations (QIOs)
Nursing homes can take advantage of weekly National Nursing Home Training that focuses on infection control, prevention and management to help prevent the transmission of COVID-19.Nursing homes can locate the QIO responsible for their state here.
The Centers for Medicare & Medicaid Services (CMS) instructed Medicare Administrative Contactors and notified Medicare Advantage plans to cover coronavirus disease 2019 (COVID-19) laboratory tests for nursing home residents and patients. This instruction follows the Centers for Disease Control and Prevention’s (CDC) recent update of COVID-19 testing guidelines for nursing homes that provides recommendations for testing of nursing home residents and patients with symptoms consistent with COVID-19 as well as for asymptomatic residents and patients who have been exposed to COVID-like symptoms in an outbreak.
Medicare Advantage plans must continue not to charge cost sharing (including deductibles, copayments, and coinsurance) or apply prior authorization or other utilization management requirements for COVID-19 tests and testing-related services.
For the full Medicare Learning Network article, CLICK HERE.
The Centers for Medicare and Medicaid Services (CMS) issued a Frequently Asked Questions document on visitation for nursing home residents that provides clarifications and considerations including:
Visitation for compassionate care situations
CMS clarifies compassionate care situations are not exclusive to end-of-life situations. An example is provided explaining a resident who was living with their family prior to being admitted to the nursing home may experience trauma due to the change in their environment and sudden lack of family. Therefore, this may qualify as a compassionate care situation.
CMS encourages creative means of connecting residents and families including visitation outside of the facility while ensuring all actions for preventing COVID-19 transmission are followed.
Residents (without COVID-19 symptoms) may eat in the same room with social distancing.
Group activities may be facilitated (for residents who have fully recovered from COVID-19, and for those not in isolation for observation, suspected or confirmed COVID-19 status) with social distancing among residents, appropriate hand hygiene, and use of a cloth face covering or facemask.
Steps for reopening to visitors
Nursing homes should continue to follow CMS and CDC guidance for preventing the transmission of COVID-19 and follow state and local direction.
CMS does not recommend reopening facilities to visitors (except for compassionate care situations) until phase three when the following criteria are met:
No new onset of COVID-19 in the nursing home for 38 days
No staff shortages
Adequate supplies of PPE and essential cleaning and disinfection supplies
Adequate access to testing for COVID-19
Referral hospitals have bed capacity on wards and ICUs
Factors to consider regarding visitation
CMS encourages that any decisions to relax requirements or conduct creative alternatives within nursing homes be made in coordination with state and local officials after a careful review of facility-level, community, and state factors/orders.
To access the complete FAQs document from CMS’ Current Emergencies webpage, CLICK HERE.
It has been said “a picture is worth a thousand words.” That quote is so true in this COVID-19 era where friends and family must keep their distance from loved ones in nursing homes. The compassion and care that nursing home staff provide includes, now more than ever, the social wellbeing of residents and patients. Sharing photographs and videos is a wonderful way to keep connected. However, don’t forget Health Insurance Portability and Accountability Act (HIPAA) compliance still is required.
Photos or videos containing any portion of a resident’s or patient’s face are considered Protected Health Information (PHI). That doesn’t mean you cannot take and share photos or videos. HIPAA allows use and disclosure of photos or videos when proper authorization is provided by the resident, patient, or responsible party.
To be HIPAA compliant, authorization documentation must include the following:
The purpose for using and disclosing photos or videos; for example, “to share with her daughter/son”
The timeframe the authorization applies; for example, “to send to daughter/son while the facility is on lockdown”
Explanation that the resident, patient, or responsible party have the right to revoke the authorization at any time
Explanation that the health care provider will not condition treatment, payment, or enrollment or eligibility for benefits on the resident, patient, or responsible party signing the authorization
Signature of the resident, patient or responsible party
Thanks to all for keeping residents and patients safe and connected while remaining HIPAA compliant.
As research and data collection regarding the recovery from COVID-19 grows, valuable information from research studies identifying correlations between contracting the virus and other acute medical complications, as well as the increased risk of readmission to the hospital, is clear. Current data suggests that patients hospitalized for COVID-19 are at increased risk for blood clots, strokes, heart and lung damage, speech and swallowing difficulties due to prolonged intubation, and neurological impairments. It is our job to have a heightened awareness of potential complications associated with COVID-19 and communicate any findings to the interdisciplinary team (IDT). With proper notification of subtle observed symptoms, the IDT can work together to minimize the side effects of COVID-19 and decrease the need for rehospitalization, consequently avoiding delayed recovery, increased potential for exposure to other contagions, and development of further complications.
Recovery is not only needed for those who have survived COVID-19; recovery, although different, is also needed for those who did not contract the virus but find themselves dealing with side effects from the modification of routines and activities in an effort to combat the spread of COVID-19. Current data shows that older adults who have not contracted the virus are seeing physical and psychosocial effects due to social distancing that result in deconditioning, increased effects of chronic disease, and reduced functional capacity. Facilities can provide ways to keep residents active while still maintaining social distancing guidelines. To thwart the effects of isolation and inability to see family, facility staff can provide technology, such as Facetime, to allow for residents to check in with their loved ones. Another consideration would be to reach out to family members and encourage them to send pictures and care packages to brighten the residents’ day. We must ensure minimal impact to those who have made the skilled nursing facility their home by increasing opportunities for social and physical activities while maintaining precautions and social distancing during the COVID-19 pandemic.
COVID-19 has touched everyone, either directly or indirectly, and the effects of the virus may linger for an indefinite amount of time. However, through increased communication among the IDT, we can potentially aid in speeding up the recovery process and in minimizing the risk of rehospitalization. Additionally, through increased social and physical opportunities, our residents who have not contracted COVID-19 can explore alternative ways to stay connected and physically active. Through the actions of a proactive interdisciplinary team, we can assist all our residents in achieving functional and quality outcomes allowing for enhanced quality of life.
Summer sunshine abounds in June! And without the extreme heat of July, it’s a great time to be outdoors soaking up wonderful, bone strengthening vitamin D. Just remember simple sun safe tips.
Must-do sun safe sun reminders:
Whether you are a new believer in protecting your skin against harmful UV rays or have been a regular protector of your skin, it’s never too late to take precautions to help ensure you don’t get too much of a good thing.
• Wear wide brimmed hats
• Show us your shades – protect the eyes
• Wear loose-fitting, long-sleeved shirts to keep cool but protect the skin
• Make sunscreen a daily morning ritual
• Take breaks in the shade and eliminate extended sun exposure