A Path Out of the Pandemic

They say change is the only thing that is constant in life. Over the past two and a half years, long-term care has been immersed in this concept. In searching for a path out of the pandemic we find ourselves facing reroutes associated with COVID re-emergence or various other infection-prevention barriers. But we are now better equipped and prepared for these detours and, with the skilled eye of assessment, can equip our residents and staff with the tools and function to emerge stronger and fortified.

Many residents were inadvertently negatively impacted by the preventative measures put into place during the pandemic, others may be experiencing lingering deficits from having contracted COVID. Their current baselines are likely not the same as their pre-pandemic baselines.  Screening processes must take this into account to ensure attainment of the highest practicable level of independence, thereby promoting confidence in a return to normalcy for residents.

Even though most facility-based activities have resumed, and therapy gyms have reopened, some residents are hesitant to participate due to residual fears related to infection. Given the new, enhanced barrier precautions outlined by CMS, some residents may see these precautions and fear a surge is imminent. To offset this, open communication, assurance, and vigilance in infection prevention and control processes is key. Implementing health literacy interventions to convey information to residents in ways they can comprehend will allay concerns, provide reassurance, and instill confidence in their home environment.

As we navigate these paths, we should step into the moments that allow us to pause, celebrating our collective endurance, cultivating new bonds through shared activities, and discovering moments of inspiration. May we prevail in constructing a hope-filled future with the permanent paths to successful outcomes.

CMS Updates Nursing Home Requirements of Participation Guidance

On June 29, 2022, the Centers for Medicare & Medicaid Services (CMS) issued updates to guidance on minimum health and safety standards that Long-Term Care (LTC) facilities must meet to participate in Medicare and Medicaid. CMS also updated and developed new guidance in the State Operations Manual (SOM) to address issues that significantly affect residents of LTC facilities.

Surveyors will begin using this guidance to identify noncompliance on October 24, 2022.

Key areas of guidance include

  • Requirements for surveyors to incorporate the use of Payroll Based Journal (PBJ) staffing data for their inspections.
    • CMS indicates the believe this will help identify potential noncompliance with CMS’ nursing staff requirements, uncover instance of insufficient staffing, and yield higher quality care. In addition, they state this allows facilities to begin addressing the staffing issues while the new rule making for minimum staffing levels is underway.
  • Requirements for an onsite at least part-time Infection Preventionist (IP) who has specialized training to effectively oversee the facilities infection prevention and control program.
    • CMS believes that the role of the Infection Preventionist (IP) is critical in the facility’s efforts to mitigate the onset and spread of infections. CMS cites the IP role as critical to mitigating infectious diseases through an effective infection prevention and control program.
  • For additional guidance and details, refer to the State Operations Manual and QSO-22-19-NH.

CMS included in memorandum QSO-22-19-NH recommendations related to resident room capacity.  There are no new regulations related to resident room capacity. However, CMS wanted to highlight the benefits of reducing the number of residents in each room given the lessons learned during the COVID-19 pandemic for preventing infections and the importance of residents’ rights to privacy and homelike environment. CMS urges providers to consider making changes to their settings to allow for a maximum of double occupancy in each room and encouraging facilities to explore ways to allow for more single occupancy rooms for nursing home residents.

Additional details can be found in the following CMS documents: QSO-22-19-NH, Press Release, Fact Sheet

A Reflection on Connection

May plays host to both National Skilled Nursing Care Week (NSNCW) and Better Hearing and Speech Month (BHSM). Although this planning may not be intentional, the themes of each celebrate their profession’s role in human connection. NSNCW’s theme of “Creating and Nurturing Connections” and BHSM’s theme of “Connecting People” could not be better timed to raise awareness and celebrate these distinct, yet entwined, professions.

Every member of the skilled nursing care team is a vital part of building connections within that facility. Oftentimes for residents, these settings are new and unfamiliar, leading to isolation and the potential for depression. Front-line healthcare workers have been instrumental in helping residents cultivate meaningful relationships, leading to improved comfort and quality of life. Opportunities for authentic, mutual connections present in different ways and allow for meaningful relationships between residents and staff to occur organically and naturally strengthen.  It is through these daily interactions with residents, families, and each other, that positive connections have been established and fostered. These connections are needed to create moments of joy and purpose for both staff and residents.

For the staff who provide encouraging smiles when the resident first arrives at the facility, the CNA who always remembers a resident’s favorite sweater, the social worker who holds a resident’s hand reassuringly and listens, the dietary aide who never forgets that a particular resident only likes Cornflakes for breakfast, the housekeeping staff member who pauses to discuss a resident’s predictions for this baseball season, the nurse who takes the extra time to help a resident Skype with her daughter, and the speech-language pathologist who ensures a resident is able to confidently voice their wishes during a care plan meeting – a week, or even a month of celebration simply does not feel adequate. These are the moments of creating and nurturing connections that should be celebrated daily. This month and every month, we applaud our teams for their role in connecting and linking the human spirit in facilities across the nation.

Quality of Life is Medically Necessary

Since the Omnibus Budget Reconciliation Act (OBRA), or the Nursing Home Reform Act of 1987, federal standards have been in place to regulate efforts to address a resident’s quality of life (QOL). These federal standards identify six principles of QOL, including: sense of well-being, satisfaction with life/oneself, self-worth/self-esteem, satisfaction with environment and care, goals, and control. New data gathered during the COVID-19 era highlights the necessity to prioritize QOL, revealing that adverse effects of isolation have resulted in cognitive, psychosocial, and physical decline for many in post-acute care settings.

Because QOL is a multi-dimensional concept, this essential component of health and wellbeing should be addressed through the comprehensive efforts of an IDT. Each member of the IDT plays a distinct role to promote a resident’s QOL. Consider implementation of some of the following interventions for improved QOL within your facility:

  • Identify resident-specific interests and provide opportunities for participation in these activities on a regular basis. Consider virtual leisure opportunities, as well.
  • Improve the resident’s health literacy to promote wellness and prevent future injury/illness.
  • Execute environmental modifications that promote greater participation for all residents in activity groups.
  • Implement a facility-wide screening process for identification of depressive symptoms in residents.
  • Offer scheduled check-ins to allow residents the opportunity to present questions/concerns.
  • Consult with key players to identify activity groups, community outings, events, speakers, and responsibilities that could serve as opportunities for resident participation.
  • Provide stress management and relaxation strategies for residents and healthcare workers in the facility.

As experts in analysis of performance and participation, PT, OT and SLP can assist in assessing the resident’s functional abilities and tailoring interventions, like those listed above, to achieve person-centered goals. With the unique lens and contribution of each additional member of the IDT, these interventions can become reality; ultimately maximizing QOL, functional outcomes, and patient satisfaction.

Spring into Action Against Weight Loss

Spring is in the air! With the arrival of a new season comes new junctures to enhance the intricate care provided to seniors. Many challenges emerged during this pandemic, but along with these challenges comes opportunity for new ideas and programming to help improve patient care and quality of life. One major area of concern that continues to “spring up” is unintentional weight loss.

Medication use, disease processes, cognitive impairments, social isolation, and depression are a few reasons why weight loss problems are often common in skilled nursing facilities. Left untreated, weight loss can lead to skin breakdown, confusion, and overall decline in function and quality of life. The risk and harm of weight loss has also been identified by the Centers for Medicare and Medicaid Services (CMS) as a trigger for focused infection control surveys.

Here are some ideas to SPRING into action against weight loss:

Shaped plates and colored dinnerware increase the vibrancy of meal presentation and help residents with cognitive impairment retain focus on meals, reduce frustration, and increase intake. Contrasting dinnerware is beneficial for those with visual impairments.

Promote healthy oral care. Oral care may be overlooked when discussing weight loss. Research shows that dental issues, ill-fitting dentures, chewing problems, and mouth pain can contribute to weight loss.

Refer residents with weight loss to rehab for screenings related to positioning needs, adaptive utensils, cognitive and communication strategy training, or any chewing or swallowing impairments.

Interview the resident and caregivers regarding all mealtime preferences, including food likes/dislikes, preferred dining location, ambiance options, and snacking habits. Residents’ meal preferences are distinct and different.

Nutrients! For residents experiencing weight loss, discuss fortification of meals with the resident’s physician and dietician. Recommendations may include fortified foods, additional supplements, frequent snacks, or increased portion sizes to maximize nutritional intake.

Grant flexibilities with mealtimes. Enable residents to have choices with how, when, and what they eat to promote patient-centered dining programs. Unfamiliar dining schedules, food choices, and mealtime settings cause disruptions in intake.

Spring brings with it new beginnings and a reminder of how rejuvenating change can be! Seasons change and so do the needs of the residents. Adjusting and changing dining culture based on the needs of the individual provides comfort, safety, and independence during meals. Patient-centered dining experiences are critical to fighting weight loss and improving patient satisfaction and quality of life.

Rediscovering Delight in Their Days

According to recent studies, older adults have experienced increased depression, loneliness, anxiety, and suicidal thoughts, as well as decreased physical health and overall quality of life as a result of COVID-19 and social isolation. As providers who relate so intimately with this population, we ask ourselves, what can we do now?

Participation in leisure, or the use of free time for enjoyment, has a large impact on the health and well-being of older adults. Research suggests that active engagement in healthy leisure can help to maintain preserved cognition, overall physical functioning, mental health, and quality of life. Now, more than ever, residents need opportunities to engage in meaningful activities that bring purpose and joy to their days. Through active collaboration and creativity from the interdisciplinary team, we can facilitate improved morale, satisfaction, and health for those in our care.  Review the following opportunities to explore ways to keep the resident’s mind, body, and spirit engaged:

  • Identify hobbies that are meaningful to the resident or activities they are willing to explore. Talk to your therapy team about the Resident’s InterestChecklist for collaborative discussion.
  • Request family and friends bring in items, games, or activities that are meaningful to the resident.
  • Use creativity to incorporate resident’s interests into the care plan. Are there activity groups, events, or outings in which the resident could participate? Are there specific roles or responsibilities the resident could “own” (i.e. delivering mail, providing daily announcements, assisting with facility decorations, leading a weekly book club discussion)?
  • Encourage participation in activities of interest during the resident’s downtime. Discuss safety precautions and resident capabilities with your therapy team.
  • Provide opportunities for virtual leisure. Online card games, weekly FaceTime calls with loved ones, online learning platforms, and digital tours through museums and galleries around the world allow for engagement despite physical barriers.
  • Communicate with your resident. Ensure that each resident feels known, heard, and cared for on both the physical and emotional level.

Although we can’t change what COVID -19 has brought to so many of our residents over the past two years, we are able to move forward with a fresh focus on their overall well-being. Through participation in healthy leisure, we can help our residents rediscover delight in their days.

A Moving Experience

October is a month of moving experiences- temporal, seasonal, and physical! It’s the beginning of the last quarter of the calendar year and the beginning of the Medicare fiscal year. It ushers in the holiday excitement with weather changes and spooky decor. Amid all of this, it is Physical Therapy Month, and an excellent opportunity to emphasize encouraging mobility for our residents at every possible opportunity. Almost daily, articles are released citing the benefits of mobility from improving appetite to improving skin integrity to preventing contractures.  With that in mind, there is a steadfast need to maintain and improve mobility with our residents.

Incorporating “moving experiences” into the daily facility routine is multifaceted and can bring holiday cheer while also embedding a culture of mobility and independence. There is no amount of too little movement- if residents are moving, benefits are happening. This may look like a high five in the hallway, door decorating contests, a shoulder shrug or leg kick “dance break” with music over the loudspeaker and referrals to therapy for concerns for safety with mobility.

It’s impossible not to think of the effect COVID-19 has had on industry as we round the second year under a healthcare emergency cloud, but we adapt. Skilled nursing residents and staff are resilient and keep looking forward. With an arsenal of wellness and mobility strategies provided to residents, we shape a holistic, healthy environment in which to thrive.  Remember, Reliant therapists are champions at mobility and are equipped to combat barriers to a quality “moving experience”. Thank you for partnering with Reliant!

Success Beyond Discharge

As skilled nursing facility providers and caregivers, we are privileged to experience many of the fruits of our patient’s progress during their stay, directly related to the services and care that we provide. We are able to share in the excitement and pride that accompanies progress towards a safe discharge to the next level of care after sustaining an often times life-altering injury or health-related episode. But what about life after discharge from our care? Are we confident that our patients and their caregivers are equipped to maintain their progress and successful outcomes, on their own?

The healthcare community, including the Centers for Medicare and Medicaid Services (CMS), emphasizes the importance of interdisciplinary, comprehensive discharge planning from the time of the patient’s admission. Recent literature suggests that the interdisciplinary team (IDT) is able to reduce hospital readmissions and facilitate successful outcomes beyond discharge through provision of high-quality discharge information, participation of the patient and caregiver in the discharge process and focus on increasing the patient and caregiver’s understanding of the discharge information (Hesselink et. al, 2014).  All skilled nursing providers play an important role in the interdisciplinary approach to discharge planning, and a collaborative partnership between therapy, facility staff, case managers, family, and the patient is paramount to success. The weight of the interdisciplinary team’s commitment to patient and caregiver preparation for the next level of care cannot be overlooked. Consider these key components of discharge planning throughout the patient’s stay:

  •  Upon admission:
    • From the time of admit, discharge plans should be considered. Goals should be developed and updated to ensure preparedness for the setting, level of assistance, and needs anticipated at discharge.
  • Throughout the episode of care:
    • Consider a system to ensure all staff are aware of the patient’s personal goals. Implement ongoing patient/caregiver education for health literacy, functional targets, and training to allow ample time for questions, problem solving, and repetition prior to time of discharge.
  • At time of discharge:
    • Provide clear, comprehensive, and accurate information regarding the patient’s discharge level of function, recommendations for equipment or follow-up care, and level of assistance or supervision for daily tasks. Enable the patient and caregiver’s understanding of skilled staff recommendations.

Reliant has created proprietary resources to guide clinicians through comprehensive, effective discharge planning. These resources can also facilitate education, trainings, and increased opportunity for IDT discussion.  Check out Reliant’s Discharge from Therapy to Community Packet and Discharge from Therapy to Nursing Packet to ensure that your patients and caregivers are properly prepared for the next level of care.

With effective discharge planning that occurs throughout the patient’s episode of care, we can facilitate carryover of learned strategies, patient and caregiver confidence, reduced risk of rehospitalization and successful outcomes beyond discharge from therapy.  Reliant is proud to partner with you to confidently guide our patients, caregivers, and staff through discharge planning that will lead to patient success beyond discharge!

References

Hesselink, G., Zegers, M., Vernooij-Dassen, M., Barach, P., Kalkman, C., Flink, M., Öhlen, G., Olsson, M., Bergenbrant, S., Orrego, C., Suñol, R., Toccafondi, G., Venneri, F., Dudzik-Urbaniak, E., Kutryba, B., Schoonhoven, L., Wollersheim, H., & European HANDOVER Research Collaborative (2014). Improving patient discharge and reducing hospital readmissions by using Intervention Mapping. BMC health services research14, 389. https://doi.org/10.1186/1472-6963-14-389

A Refresher on Fall Prevention Strategies

As the Delta variant of COVID surges through the country, long-term care facilities are forced to revisit the effects of closure, social distancing, and isolation on residents.  This variant has caused healthcare professionals to reframe thinking from potentially leaving a pandemic behind, to best practice strategies to mitigate an ongoing response pattern. Facility staff should revisit the impact moving in and out of isolation has on residents. Consequently, a refresher on fall prevention strategies is appropriate.

Isolation has detrimental effects including reduced mobility, decreased cognition, increased depression, weight loss, and increased risk for falls. While the list of obstacles at times seems insurmountable, keen interdisciplinary teams can be a shining light to our residents by constantly adapting, advocating, evolving, and simply showing up. Though increased isolation may lead to residents spending more time alone, unsupervised in their rooms, putting them at an increased risk for falls, there are ways to reduce this risk through a proactive, interdisciplinary team approach.

Consider implementation of these simple tips to help mitigate the risk of falls:

  1. Keep frequently used items within reach, especially the call button.
  2. Educate new staff on residents’ preferences and nighttime routines: lights on/off, TV on/off, toileting schedule, bed positioning, etc.  
  3. Make time to reassure residents who are feeling isolated and lonely.  Even 2-3 minutes of non-task-oriented company is beneficial. Set up virtual visits with family and friends. Decreased anxiety and agitation lead to calmer residents, and hopefully, fewer falls.
  4. Place any mobility devices in the best position for self-transfer; remove if unable to self-transfer to avoid fall risks.
  5. Take extra care to reduce clutter and ensure clear pathways in the residents’ rooms. Remove any throw rugs or items that may be blocking pathways.
  6. Ensure exercise programs, including therapy, stretching, and balance activities are available to all residents as appropriate. Improved strength and balance can assist with fall prevention and help lessen injuries should a fall occur.
  7. Identify residents’ interests and collaborate with the interdisciplinary team to facilitate creative ways for them to participate in preferred leisure activities.  
  8. Refer to physical therapy for balance strategies, assistive device assessment and training, strengthening, transfer training, gait assessment and training, bed mobility training, education on fall prevention, and floor transfers.
  9. Refer to occupational therapy for strength training, balance training, transfers and bed mobility training, facilitation of self-care independence, adaptive equipment training, education on safety awareness, room modifications, and/or cognitive training.
  10. Refer to speech therapy for expressive and receptive communication skills training and strategies, memory, attention to task, sequencing, and safety awareness training techniques.

Educate staff to watch for signs and/or changes which may reflect an increased risk for falls and proactively adapt environments at every level. With a team approach of collaboration and communication, facilities are well equipped to not only reduce the risk of falls for this vulnerable population, but also to ensure that No Patient is Left Behind.  

A Motivating Movement: Promoting Restorative Care Through Everyday Activities

As the occupancy of residents in our facilities begins to rebound, labor challenges appear to be one of the biggest dilemmas nursing home operators are facing. With staffing shortages, it may be difficult to implement optimal programming; however, as healthcare professionals in skilled nursing we are governed by the overarching concepts of quality of life, quality of care, and patient-centered care that are present in the 2016 Medicare and Medicaid Program Reform of Requirements for Long Term Care Facilities (81 FR 68688). These requirements provide the minimum framework of effective care regardless of resource availability or staffing.

Facility staff members should feel empowered to live a culture that improves resident’s quality of life and promotes healthy aging.  Providing extra “care on the move” throughout the day while performing usual daily tasks makes a tremendous difference and allows facilities to meet federal requirements.  Providing “care on the move” allows facilities who are facing staffing challenges or inconsistent program execution to meet residents’ needs and potentially document their “moves” on the MDS.

A key element at the center of this quality-of-life promotion is emphasizing resident’s ability versus disability and capitalizing on what the resident can do over what they cannot.  Some examples of “care on the move” that take advantage of improving or maintaining abilities include:

  • Allow any resident who is able to ambulate short distances or propel themself in their wheelchair, to mobilize to and from daily weight checks.
  • Use daily assist with dressing and grooming as a time to incorporate effective communication by allowing time for conversation and encouraging the resident to express wants/needs, and complete tasks as independently as possible.
  • When a resident is toileting, provide encouraging verbal cues versus automatic physical assist, as much as safely possible, to allow for maximal independence.
  • Utilize bed mobility and transfers with a resident as an opportunity to encourage the use of bed rails; and to provide training for rolling, supine to sit, and positioning themself in bed.
  • Use the facility PA system to elicit facility-wide range of motion activities. For example, when music is played, all restorative trained staff take time to assist with range of motion goals or perform sit to stand activities with the residents.

The moments spent reinforcing residents’ abilities builds both resident and staff confidence and satisfaction, and ultimately improves quality of life. For those facilities that have restorative nursing programs in place, “care on the move” is an additional avenue to promote the health and wellness of residents. In the face of challenges, we must do our part to ensure that our residents’ care needs come first. Lead the way with your interprofessional team by providing your residents those extra moves that make a difference!  

The Sweet and Salty of Return to Normalcy

As the public healthcare emergency (PHE) lightens and with vaccines abundant in the U.S., many businesses are feeling a note of normalcy. Nursing homes have been given the green light to reopen, but continue to be a target of investigation, regulatory ribbon, and reduced consumer trust. This paradoxical environment highlights the sweet and salty of long-term care (LTC). Prior to the pandemic, LTC’s focus was enhancing resident’s outcomes, improving quality of care and quality of life, and fostering a home environment worthy of the residents within.  As difficult as it may have been in the moment, we now know it was truly the sweet stuff.

During the height of the PHE, regulation and policy aligned to create a salty recipe for long-term care. Reporting requirements, acquiring PPE, reduced access to care, and navigating surveys overshadowed previous focuses. Through this pandemic, we’ve learned the necessity of the salty. Salt brings balance and accountability, but when added without first testing the effectiveness of current spices, it can quickly ruin a meal. When regulation, reporting, and accountability metrics are balanced in relation to care needs, quality outcomes, and resident satisfaction, a delightful sweet and salty mix, in high demand for any consumer, is created.

As we emerge into this new era, many are fatigued, short staffed, and considering alternatives to long-term care. Let’s partner together to remember the sweet, learn from the salty, and create an enhanced recipe. Embrace each step of reopening with a dash of optimism and a cup of determination. Give a patient a hug, ignite communal dining and activities with fanfare, have a welcome party in the therapy gym, hype the benefits of group therapy, and celebrate family and friend’s visitation! Talk openly about the expectations for infection control, safety measures, and possible temporary isolation needs. This balance will help achieve a transparent trust with our residents, their loved ones, and care partners.

Don’t let the sweet get lost in the salty, share resident and facility successes with Reliant’s Model 103.0 reports. Spotlight Reliant therapists who exhibit clinical excellence by climbing the Clinical Ladder and facility team who SMILE with purpose. Never hesitate to GROW your brand. Our partnership brings the best ingredients to demonstrate your facility’s value, skill, and compassion in the community. Bon Appetit!

Celebrating SLPs and Their Distinct Role Within the IDT

The field of speech pathology grew in the 1920s as clinicians began to work with soldiers, returning home from World War II, suffering from brain injuries. Since then, speech and language pathologists (SLPs) have helped countless individuals as experts in the field of communication, swallowing disorders, and cognitive impairments in a variety of settings.

As we celebrate Better Hearing and Speech Month, we recognize SLPs and acknowledge their immense influence in improving the quality of our residents’ lives and being key members within our interdisciplinary teams (IDT).

With the introduction of the patient driven payment model (PDPM) in recent years, SLPs are now more than ever actively engaged with the IDT to ensure the MDS accurately portrays the residents’ clinical characteristics and skilled need. Since SLPs are qualified leaders in the areas of cognitive-linguistic impairments and dysphagia, including them in conversations as the MDS coordinator completes sections C, K, and I, can improve the accuracy of these assessment areas, as accuracy of the MDS remains a critical component of the PDPM and ensures resources are available for each resident’s unique needs. By working with the nursing team, SLPs also provide a multi-disciplinary approach to patient care that is focused on patient outcomes, ensuring both quality of life and quality of care expectations are exceeded.

Recently, as a result of SNFs receiving an unintended increase in payments,  CMS has expressed its intention of recalibrating the PDPM “as quickly as possible,” in an attempt to restore it to the original budget-neutral goal. As CMS continues to monitor PDPM and its effects on payments, the IDT will need to ensure accurate and thorough medical documentation is present within the patients’ charts. Due to a sharp change in utilization for speech resources, CMS will be reviewing cases to ensure that speech services were directly linked to a doctor’s order, such as for patients with swallowing issues who require a modified diet.

This month we pause to thank our SLPs and their dedication. Since the inception of the field of speech and language pathology, SLPs continue to rise to the challenge daily. Staying abreast of the latest advances in their field including regulatory changes and requirements, they continue to advocate for the necessity of speech language pathology interventions for the safety and well-being of individuals. SLPs remain a valuable asset to the IDT as a facility leader in dysphagia management, communication and cognitive interventions, and patient and caregiver education.

With Them for the Long Haul

According to Harvard Health Blog, recent studies indicate that 50-80% of patients recovered from COVID-19 continue to have at least one adverse symptom three months after the onset, even if the patient no longer tests positive for the virus.  This emerging condition has been described using a variety of terms including: “Post-Covid-19 Syndrome”, “Long COVID”, “Post-Acute Sequelae of SARS-COV2 infection (PASC)”, and “Long-Haulers”.  As healthcare providers to the most vulnerable population, it is our duty to monitor the evolving evidence in this area and adapt for timely identification and intervention of needs.  

Though what predisposes an individual to developing “Long COVID” is still unknown, a number of those with even mild symptoms have continued to experience lingering effects. Some of the troublesome symptoms that have been observed with “Long COVID” include many of the same musculoskeletal, cardiopulmonary, oral/respiratory, neurological, and psychological dysfunctions that are seen with active COVID-19. Furthermore, it has been noted that some individuals recovering from COVID-19 develop new conditions or complications of pre-existing conditions as a result of the illness.

Rehabilitation’s distinct role in COVID recovery and “Long COVID” is clear. Therapy can intervene to assist “Long Hauler” patients by maximizing their participation and performance in daily function with the use of the following:

  • Referral to the IDT when changes in clinical presentation emerge
  • Patient-specific musculoskeletal and neurological re-training
  • Individualized cardiopulmonary programming
  • Dysphagia analysis and treatment
  • Compensatory strategies to assist with cognitive re-training
  • Environmental modifications to facilitate increased participation and decreased risk of injury
  • Trauma-informed approaches to care when addressing the psychological effects of prolonged isolation
  • Patient and caregiver training on adaptive techniques and equipment
  • Patient education to promote health literacy

Reliant is actively engaged with the therapists in the field by developing resources such as Reliant’s Post COVID Clinical Considerations in order to equip the care team to positively impact patients and residents. Evidence continues to emerge, but the tools and knowledge do exist to address the physical, cognitive, and psychosocial needs that COVID-19 has introduced. Whether newly diagnosed as COVID positive, challenged by long-term effects of “Long COVID”, or facing an entirely new condition as a result of COVID-19, a patient or resident will never feel alone as they can rest assured that we’re with them for the long haul.

References:

Anthony Komaroff, MD. “The Tragedy of Long COVID.” Harvard Health Blog, 1 Mar. 2021, www.health.harvard.edu/blog/the-tragedy-of-the-post-covid-long-haulers-2020101521173.

AOTA. “Research: Occupational Therapy and Physical Therapy Provide Significant Rehabilitative Value in Post-Acute Care.” American Occupational Therapy Association, 5 Apr. 2021, www.aota.org/Advocacy-Policy/Federal-Reg-Affairs/Therapy-Outcomes-Post-Acute-Settings.aspx.

Cutter, Matthew. “COVID Long-Haulers: An End in Sight?” ASHAWire, 5 Mar. 2021, leader.pubs.asha.org/do/10.1044/leader.FTR1.26032021.42/full/.

Royal College of Occupational Therapists. “A Quick Guide for Occupational Therapists: Rehabilitation for People Recovering from COVID-19.” Rcot.co.uk, Apr. 2020, www.rcot.co.uk/files/guidance-quick-guide-occupational-therapists-rehabilitation-people-recovering-covid-19-2020.

WHO. “COVID-19 Clinical Management: Living Guidance.” World Health Organization, World Health Organization, 25 Jan. 2021, www.who.int/publications/i/item/WHO-2019-nCoV-clinical-2021-1.

The Distinct Value of Physical Therapy in Trauma-Informed Care

About 70% of adults in the U.S. have experienced at least one traumatic event in their life.1 COVID-19 may have resulted in a traumatic experience for many, while for others it may have triggered re-traumatization from past experiences. The experience of trauma or re-traumatization during a patient’s rehab stay cannot only result in physical, psychological, and emotional health conditions, but also impede therapeutic rapport, the patient’s feelings of safety, and the overall healing and recovery process.  By putting into practice the core principles of trauma-informed care (TIC): patient empowerment, choice, collaboration, safety, and trustworthiness, physical therapists can help prevent trauma and re-traumatization while increasing overall patient health and well-being.

Physical therapists have a responsibility to become trauma-informed and respond to each patient’s needs with a holistic approach by preventing re-traumatization and creating a supportive and safe environment for a patient’s rehabilitation journey. When the therapy team has been alerted to a history of trauma or is aware of a particularly stressing event such as loss or isolation during the pandemic, consider this history during the development of goals and treatment approaches.  For example, provide education on the impact and empowerment associated with improving the level of independence with bed mobility or transfers. Assess and modify environmental factors that trigger re-traumatization. Other tips to implement through interventions may include identifying alternative approaches to physical assistance (i.e., sit to stand assistance with equipment support instead of hands-on approach), clearly communicating the purpose and process of the activity before providing manual interventions (i.e., explaining hand placement before intervention initiated), and identifying and respecting preferences (i.e., gender preference with close interactions such as bed mobility tasks).

Many of the patients we serve have a history of trauma or may be experiencing a traumatic experience through their illness or injury.  Some have faced loss through COVID-19, while others may internalize fear and uncertainty through prolonged hospitalization and isolation in response to the pandemic.  Trauma has lasting implications on an individual’s health and well-being. The physical therapist that approaches each individualized plan of care with function and the emotional well-being of the patient first and foremost will demonstrate the distinct value of physical therapy in trauma-informed care.

National Council for Behavioral Health. (2015, Jan 8). Retrieved March 8, 2021, from https://www.thenationalcouncil.org/BH365/2015/01/08/strengthening-personal-community-resilience-mitigate-impact-disaster-trauma/.

Intentional Ideas to Fuel Your Residents with Unintended Weight Loss

To those working on the front lines in nursing homes and skilled nursing facilities, it comes as no surprise to hear that CMS is directing state surveyors to be alert and investigate those residents experiencing a significant decline in their condition during the pandemic particularly those residents with weight loss and/or a decline in mobility. As we know, weight loss and changes in mobility can be a direct effect of increased social isolation resulting from the healthcare emergency.  Essential quarantine and social distancing come with a high cost for our seniors who already experience higher incidences of loneliness and isolation. Healthcare professionals have the skills to address the wide range of challenges that increased isolation has introduced to our long-term care residents.

Decreased taste and smell and diminished appetite can lead to poor eating habits and weight loss, and unfortunately these are often devastating side effects that isolation and various illnesses generate. Weight loss can cause complications ranging from dehydration and increased confusion to increased risk of skin breakdown, all of which inadvertently lead to decreased ADL and functional mobility independence.

There are many ways appetite can be encouraged within your facilities, including the following:

  • Offer small meals often including protein packed small meals/snacks several times a day.
  • Trend meal intake and maximize snack or mealtimes reflective of better appetite. If you know that a resident traditionally eats more in the evening, use that time to offer favorite, protein-rich foods.
  • Train and engage all staff in meal assistance including administrators and activities staff to assist with meal set up and feeding (opening cartons, cutting meat, self-feeding, encouragement).
  • As infection control allows, offer the structure of eating at a table as opposed to alone in the room or in bed.
  • Remove wrappings, boxes or covers and move food to an actual plate/bowl so that food looks homemade and appetizing.
  • Fortify food with things like yogurt, cream, honey, butter, and/or oats to meals to increase caloric intake and boost energy.
  • Always have snacks and beverages handy. Make eating a communal event as much as possible while following infection control precautions. Meals should be enjoyable and not rushed.
  • Enlist family member support when able.  Have them join the resident virtually for meals.
  • Remember that food has to be eaten to count. Honor resident choice and encourage selection of favorite foods, even if it’s cereal for supper!
  • Coordinate opportunities with therapy and activities to encourage exercise and activity to help stimulate a healthy appetite.  
  • Timing therapy sessions to assist patients in routine daily functions including getting dressed and out of bed for meals to improve alertness and mobility for safe intake of meals/snacks.
  • Refer for speech or occupational therapy screening when safe chewing/swallowing or self-feeding or positioning are of concern.

Fun fact: Did you know that the scent of cinnamon, citrus, spearmint, and peppermint can all stimulate appetite and alertness?

As the public health emergency continues, we must continue to rise to our residents’ needs. It is crucial to be diligent about monitoring weight and enriching resident care plans with nutritional and physical activity interventions to prevent weight loss. The keys to successful resident outcomes during a pandemic are knowledge, communication, and collaboration. Reliant Rehabilitation is proud to partner with you, your staff, and your residents!

COVID-19 Vaccine Resources

With the increasing availability of COVID-19 vaccinations on the horizon and updated information being released almost daily, organizing the pertinent material into a concise usable format can be daunting. Below are the most up-to-date resources from the CDC, CMS, and FDA regarding the COVID-19 vaccine.

CDC Vaccine Resources

CMS Vaccine Resources

FDA Vaccine Resources

CMS Provides Updated Guidance for Use of Waivers

CMS has updated its guidance and provided specific instructions for using the Qualified Hospital Stay (QHS) and benefit period waivers, as well as how this affects claims processing and SNF patient assessments.

  • To bill for the QHS waiver, include the DR condition code. To bill for the benefit period waiver:
    • Submit a final discharge claim on day 101 with patient status 01, discharge to home.
    • Readmit the beneficiary to start the benefit period waiver.
  • For ALL admissions under the benefit period waiver (within the same spell of illness):
    • Complete a 5-day PPS Assessment. (The interrupted stay policy does not apply.)
    • Follow all SNF Patient-Driven Payment Model (PDPM) assessment rules.
    • Include the HIPPS code derived from the new 5-day assessment on the claim.
    • The variable per diem schedule begins from Day 1.
  • For ALL SNF benefit period waiver claims (within the same spell of illness), include the following:
    • Condition code DR – identifies the claims as related to the PHE
    • Condition code 57 (readmission) – this will bypass edits related to the 3-day stay being within 30 days
    • COVID 100 in the remarks – this identifies the claims as a benefit period waiver request

Note: Providers may utilize the additional 100 SNF benefit days at any time within the same spell of illness.

Claims are not required to contain the above coding for ALL benefit period waiver claims.

Example: If a benefit waiver claim was paid utilizing 70 of the additional SNF benefit days and the beneficiary either was discharged or fell below a skilled level of care for 20 days, the beneficiary may subsequently utilize the remaining 30 additional SNF benefit days as along as the resumption of SNF care occurs within 60 days (that is, within the same spell of illness).

Additional instructions can be found in the article if you previously submitted a claim for a one-time benefit period waiver that rejected for exhausted benefits.

CLICK HERE to view the MLN Matters article.

CLICK HERE for the updated list of blanket waivers available.

CMS to retire the original Compare Tools on December 1

Use Medicare.gov’s Care Compare to find and compare health care providers.

In early September, the Centers for Medicare & Medicaid Services (CMS) released Care Compare on Medicare.gov, which streamlines the eight original health care compare tools. The eight original compare tools – like Nursing Home Compare, Hospital Compare, Physician Compare – will be retired on December 1st. CMS urges consumers and providers to:

  • Use Care Compare on Medicare.gov and encourage people with Medicare and their caregivers to start using it, too. Go to Medicare.gov and choose “Find care”.
  • Update any links to the eight original care tools on your public-facing websites so they’ll direct your audiences to Care Compare.

With just one click on Care Compare, easy-to-understand information about nursing homes, hospitals, doctors, and other health care providers is available.

Information about health care providers and CMS quality data will be available on Care Compare, as well as via download from CMS publicly reported data from the Provider Data Catalog on CMS.gov.


Direct links to the tools & additional resources

Care Compare on Medicare.govhttps://www.medicare.gov/care-compare/

Provider Data Catalog on CMS.govhttps://data.cms.gov/provider-data/

Care Compare resources for consumers and partners – Medicare blog, Promotional video, Conference card  

Full Press Release: https://www.cms.gov/newsroom/press-releases/cms-care-compare-empowers-patients-when-making-important-health-care-decisions

Triumphs During Trying Times

The holiday brings with it an important time of reflection. As we gather around our proverbial table with you as part of our Reliant family, we pause to remind ourselves that despite the profuse and unique challenges of 2020, there were numerous successes for which to be grateful. While the list of obstacles at times seemed insurmountable, we continued to be a light to our patients – constantly adapting, advocating, evolving, leaning on our interdisciplinary team members, and showing up despite unsettling moments, and at times, heartbreaking losses.

Essential staff have risen as infection control heroes. We protected our residents, ourselves, and our loved ones through diligent processes as vigilance became a top priority. We met these challenges by solidifying our knowledge of infection prevention and control, provision of care for those in isolation, and proper use of personal protective equipment. The procedures and protocols developed this year will, no doubt, continue to ensure everyone’s safety in the long run.

Isolation and quarantine became a daily reality in an attempt to prevent and mitigate infection spread. Reliant clinicians continue to combat this by brainstorming and executing some impressive, heart-warming, therapeutic activities that provide much needed social interactions, safely. For example, our Sterling Oaks Rehab team built an actual lemonade stand to help the residents celebrate the end of summer, Northern Nevada Veterans Home created a resident carnival for their patients, and there were many more examples. They also incorporated daily care needs into their skilled treatment sessions to assist nursing staff. Countless other interdisciplinary teams facilitated “visits” through video calls or even through windows with patients and their families during quarantine.

This year, thousands of long-term care providers and therapists banded together to make their voices heard. Our respective, discipline-specific associations and The National Association for the Support of Long Term Care (NASL) enabled a multitude of health care providers to voice their concerns creating a powerful advocacy force and gateway to facilitate action. Advocacy measures impacted bipartisan legislation to continue to fight against cuts that would affect service provision for those who need it the most, proving that advocacy does matter!

As vaccine and treatment options appear imminent, even on the cusp of again increasing cases, we can go forward with knowledge, confidence, and determination to continue to protect and fight for our residents.  So this year, as we sit around our “Reliant table” and share feelings of gratitude with and for one another, despite having to hold each other’s gloved hands and speak through masks, we hope you feel and sense accomplishment and gratitude, and that you are smiling under those masks, knowing that we stood together on the precipice of the unknown and found resilience, meeting daily demands with continued hope beyond the present circumstances. 

Core Principles of COVID-19 Infection Prevention

  • Screening of all who enter the facility for signs and symptoms of COVID-19 (e.g., temperature checks, questions or observations about signs or symptoms), and denial of entry of those with signs or symptoms
  • Hand hygiene (use of alcohol-based hand rub is preferred)
  • Face covering or mask (covering mouth and nose)
  • Social distancing at least six feet between persons
  • Instructional signage throughout the facility and proper visitor education on COVID-19 signs and symptoms, infection control precautions, other applicable facility practices (e.g., use of face covering or mask, specified entries, exits and routes to designated areas, hand hygiene)
  • Cleaning and disinfecting high frequency touched surfaces in the facility often, and designated visitation areas after each visit
  • Appropriate staff use of Personal Protective Equipment (PPE)
  • Effective cohorting of residents (e.g., separate areas dedicated COVID-19 care)
  • Resident and staff testing conducted as required at 42 CFR 483.80(h) (see QSO-20- 38-NH)