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MDS Changes Countdown – Day 1

COUNTDOWN DAY 1: Interdisciplinary Collaboration

When it comes to MDS assessments, teamwork makes the dream work. The MDS is a critical component of comprehensive resident care in long-term care facilities. Completing these assessments effectively requires an interdisciplinary team (IDT) approach. Interdisciplinary collaboration in MDS streamlines the assessment process and has the power to elevate the quality of care delivered to residents.

IDT meetings are the cornerstone of effective interdisciplinary collaboration, and the frequency of these meetings should be carefully considered. Regular meetings provide a platform for team members to share insights, discuss resident cases, and align on care plans.

Effective communication is at the heart of interdisciplinary collaboration. To create meaningful plans of care, it is crucial to communicate with various IDT members. This includes residents themselves, other disciplines who have recently interacted with the resident, direct staff from all shifts, and the resident’s physician. Each of these sources can provide valuable insights into the resident’s condition, preferences, and progress. By involving multiple disciplines, care plans can be tailored to align with the resident’s unique preferences and goals. This ensures that residents not only receive medically necessary care, but also maintain their dignity and quality of life.

Achieving success in MDS assessments is a collective effort. By fostering interdisciplinary collaboration, long-term care facilities can navigate the evolving landscape of MDS assessments while continuing to deliver high-quality, resident-centered care. Collaboration truly is the key to unlocking success in resident assessments and care planning. 

Reliant’s Interdisciplinary Team Meeting Clinical Resource

IN CASE YOU MISSED IT

 

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MDS Changes Countdown – Day 2

COUNTDOWN DAY 2: Quality Measure Impact

Minimum data set (MDS) assessments provide the data foundation for many quality measures. The transition from MDS 3.0 version 1.17.2 to version 1.18.11 brings significant impacts to several quality measure specifications; one of the biggest changes being the shift from Section G: Functional Status to Section GG: Functional Abilities and Goals, as well as the inability to generate a RUG-IV grouper directly impacting staffing measures.

To account for these changes, CMS released Minimum Data Set (MDS) 3.0 Quality Measures (QM) User’s Manual V16.0 and Nursing Home Five-Star Quality Rating System: Technical Users’ Guide last week.

Quality Measure Updates:
New Measures

  • SNF Discharge Function Score measure (CMS ID: S042.01) will replace Percent of Residents Who Made Improvements in Function (Short Stay) (CMS ID: N037.03)
  • Percent of Residents With Pressure Ulcers (Long Stay) (CMS ID: N045.01) will replace Percent of High-Risk Residents With Pressure Ulcers (LS) (CMS ID: N015.03)
  • Percent of Residents With New or Worsened Bowel or Bladder Incontinence (LS) (CMS ID: N046.01) will replace Percent of Low-Risk Residents Who Lose Control of Their Bowel or Bladder (Long Stay) (CMS ID: N025.02)

Re-specified Measures to utilize Section GG items due to the removal of Section G

  • Percent of Residents Whose Need for Help with Activities of Daily Living Has Increased (Long Stay) (CMS ID: N028.03)
  • Percent of Residents Whose Ability to Walk Independently Worsened (LS) (CMS ID: N035.04)

Starting in April 2024, CMS will freeze (hold constant) impacted quality measures on Nursing Home Care Compare.

Public reporting for these measures is scheduled to resume in January 2025 or as soon as technically feasible.

Nursing Home Five-Star Quality Rating Staffing Updates

  • In July 2024, CMS will post nursing home staffing measures based on the new staffing case-mix adjustment methodology derived from PDPM as outlined in the appendix: “Updated Case-Mix Adjustment Methodology for Staffing Level Measures”
  • CMS will revise the staffing rating thresholds to maintain the same overall distribution of points for affected staffing measures.
  • Beginning in April 2024, CMS will freeze (i.e., hold constant) the staffing measures for three months while they transition to a SNF payment PDPM replacing the RUG-IV methodology.

Resources

Be on the lookout for tomorrow’s blog: Interdisciplinary Communication

IN CASE YOU MISSED IT

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MDS Changes Countdown – Day 3

COUNTDOWN DAY 3: Impact to State Case Mix

Federal regulations mandate that all nursing facilities, regardless of the Medicaid system in their state, must conduct patient specific MDS assessments, known as OBRA assessments, at specific intervals for each resident, regardless of their payer. Many states utilize these federally mandated MDS assessments to inform and calculate the case mix index (CMI). For decades, case mix states have adopted models for the MDS assessment that are similar to the Prospective Payment System (PPS) of their time, such as RUGs III or IV. However, beginning 10/1/2023, federal support for the calculation of RUG scores will end. States who continue to apply RUG methodology will have to implement the Optional State Assessment (OSA) which can no longer be combined with any other assessment. The MDS v. 1.18.11 will only support PDPM determinations. In an effort to prepare for this change, states that implement a Case Mix system, may be transitioning or have already transitioned to PDPM.

While case-mix methodologies vary from state-to-state, there are universal strategies to enhance CMI, regardless of individual state practices:

  • Timing is everything: Ensure each member of the interdisciplinary team (IDT) has the most up to date calendar of quarterly and annual Assessment Reference Dates (ARDs).
  • Verify your state plan as of 10/1/2023 for Case Mix determination and whether the OSA will be required.
  • Ensure the IDT is trained to conduct interviews timely and accurately so that all relevant information is recorded (See Section GG Assessment Quick Card).
  • Plan, implement, communicate, and assess processes for effectiveness regularly.

In the event your state is continuing to require the use of the OSA, the OSA Manual provides these instructions/coding tips:

  • Not federally mandated, but may be mandated by state
  • Contact state for clarification
  • Must be a stand-alone assessment

Effective case mix management through thorough and complete MDS assessments are critical. Now more than ever, it is essential for each member of the IDT to be educated about the changes, enabling them to contribute their expertise accordingly. Navigating case mix management through evolving payment structures is challenging, but with effective systems in place, success can be both achievable and sustainable.

Resources

Be on the lookout for tomorrow’s blog: Quality Measure Updates

IN CASE YOU MISSED IT

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MDS Changes Countdown – Day 4

COUNTDOWN DAY 4:
Care Area Triggers and Care Area Assessments

The Care Area Assessment (CAA) process is designed to assist assessors in systematically interpreting the information recorded on the MDS. This process enables clinicians to focus on key issues identified during assessments so decisions as to whether and how to intervene can be explored with the resident.

The MDS information, coupled with the CAA process, forms the foundation upon which care plans are developed. Within this framework, there are 20 problem-oriented CAAs, each incorporating MDS-based “trigger” conditions that signal the need for additional assessment and review of the triggered care area.

Previously, Section G items were used to trigger Care Areas in the MDS; however, with the retirement of Section G, CMS has updated Appendix C (CAA Resources), placing a much larger emphasis on Section GG for the CAA process. In fact, 17 of the 20 Care Areas now utilize Section GG as triggers or indicators for the Care Area.

Therefore, accurate Section GG assessment is imperative to ensure precise mapping within the Care Area Assessment process. It serves as a crucial link between the MDS and the development of each resident’s care plan. Strong interdisciplinary collaboration should extend throughout the MDS assessment process and continue during the CAA process. By understanding the components and the importance of accurate assessment, healthcare professionals can ensure thorough resident-centered care plans are developed that promote each resident’s optimal outcomes.

Be on the lookout for tomorrow’s blog: Impact to State Case Mix

IN CASE YOU MISSED IT:

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MDS Changes Countdown – Day 5

COUNTDOWN DAY 5: Section D – Mood

Beginning October 1st, the depression screening tool in the Minimum Data Set (MDS) will transition to the PHQ-2 to 9©. The PHQ-2 to 9© introduces a skip pattern logic to guide the completion of the depression screener.

The resident mood interview begins with two gateway questions that address the cardinal symptoms of depression: a persistent depressed mood and an inability to experience pleasure. By honing in on these symptoms, this tool can quickly identify those who may be at risk for depression. Based on the responses to the first two questions, the interview will either end or continue through the remaining seven questions. The embedded skip pattern is designed to reduce the length of the interview assessment for residents who fail to report the cardinal symptoms of depression. Although the interview coding may conclude with the first two questions, asking the remaining questions provides insight to the resident’s thoughts, feelings, and ideas can provide insight and impact care planning.

Beyond the initial screening, the information gathered from the PHQ-2 to 9© interview plays a crucial role in guiding supportive treatment planning and resource utilization, including:

  • Nursing component classification in the Patient Driven Payment Model (PDPM).
  • Addressing the physical, mental, emotional, social, and spiritual factors contributing to the resident’s ability to participate in meaningful activities.
  • Implementing leisure or identified interests within therapy sessions.
  • Facilitating participation in activities of interest outside of therapy.
  • Improving the resident’s health literacy to promote overall wellness.
  • Initiating referrals for additional evaluation of possible depression or other mood disorders.

Early identification of residents at risk for depression will allow for healthcare providers to intervene more effectively and efficiently. This proactive approach can lead to timely interventions and better outcomes for patients struggling with depression.

Resources

Be on the lookout for tomorrow’s blog: Care Area Triggers & Care Area Assessments

IN CASE YOU MISSED IT:

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MDS Changes Countdown – Day 6

COUNTDOWN DAY 6: Section GG – Functional Abilities

Gone are the days of the “rule of 3” and ADL self-performance versus support provided. In less than 2 weeks, Section G will be retired on all federal assessments, and Section GG will be the center of the MDS self-care and mobility universe. Elements of Section G will be transitioning to Section GG as outlined in the provided crosswalk.

Section GG is used in healthcare settings to assess functional abilities and care needs of residents. The data collected through this assessment serves as the foundation for creating individualized care plans designed to address each resident’s unique needs and goals. Accurate scoring of Section GG will become crucial in Care Area Assessments and Care Area Triggers (CATs), fundamentally shaping each resident’s individualized plan of care. Of the twenty Care Areas, seventeen use Section GG as CATs or indicators, thereby charting a new course in the determination of care needs. Additionally, Section GG will have a greater impact on 5-Star ratings, SNF quality reporting program (QRP), and SNF value-based purchasing (VBP) initiatives.

As healthcare facilities gear up for this monumental change, it is imperative that staff members proactively address additional training requirements. This includes a change in existing facility processes, a thorough review of coding language, aligning with the parameters of Section GG, and review of GG assessment periods. It is critical to foster a culture of strong interdisciplinary team (IDT) collaboration. By sharing expertise and insights from all departments within the facility, a seamless and successful transition to the era of Section GG can be assured.

Be on the lookout for Monday’s blog: Section D – Mood.

In Case You Missed It

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MDC Changes Countdown – Day 7

COUNTDOWN DAY 7: Additions, Modifications, and Clarifications

The upcoming revisions to the minimum data set (MDS) scheduled for October 1st bring significant changes. These revisions encompass 29 new and modified data elements, updates to 13 care area triggers, and modifications to 17 care area assessment worksheets. Notably, this update introduces gender neutral language and fully integrates the IMPACT Act of 2014 Standardized Patient Assessment Data Elements (SPADEs).

Below are just a few of the additions, modifications, and clarifications to review:

  • Medication List to Subsequent Provider/Resident (A2121-A2124) – New Data Elements
  • Pain Interference with Therapy Activities (J0520) – New Data Element
  • Nutritional Approaches (K0520) – Modification
  • Skin Conditions (M0300A-G) – Modification
  • High-Risk Drug Classes: Use and Indication (N0415) – Modification
  • Special Treatments, Procedures, and Programs (O0100) – Modification

The latest clarification is in relation to quality measures. CMS has released the Minimum Data Set (MDS) 3.0 Quality Measures (QM) User’s Manual V16.0 stating that one of the biggest changes involves the transition from Section G: Functional Status to Section GG: Functional Abilities and Goals.

These changes have broad implications for long-term care facilities. Proper training of staff is essential for a smooth implementation process. Staying updated is crucial for maintaining high-quality patient care and compliance with regulatory standards. Download the MDS 3.0 v1.18.11 RAI manual to guide successful implementation of all the new additions, modifications, and clarifications.

Be on the lookout for tomorrow’s blog: Section GG – Functional Abilities.

IN CASE YOU MISSED IT:

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MDS Changes Countdown – Day 8

COUNTDOWN DAY 8: Social Determinants of Health

When it comes to assessing and improving healthcare outcomes, it is not just about medical conditions and treatment. Understanding the social determinants of health (SDOH), that encompass various factors affecting people’s lives and impacting their well-being is crucial. These include socioeconomic status, education, neighborhood and physical environment, employment, and social support networks. The SDOH play a significant role in shaping an individual’s overall health as well as access to healthcare. 

To address the impact of the SDOH, the Centers for Medicare & Medicaid Services (CMS) has identified seven critical data elements for cross-setting standardization in assessment: 

  1. Race
  2. Ethnicity
  3. Preferred language
  4. Interpreter services 
  5. Health literacy
  6. Transportation
  7. Social isolation

Collecting data on these social determinants of health is about more than just checking boxes. It is an opportunity to gain insight into residents’ lives, beliefs, and values. The responses obtained during resident interviews paint a more comprehensive picture of potential barriers each resident may face upon discharge. By acknowledging and addressing these barriers, healthcare providers can better set residents up for success and in turn, reduce hospital readmissions and foster sustainable outcomes. 

Be on the lookout for tomorrow’s blog: Additions, Modifications, and Clarifications.

IN CASE YOU MISSED IT:

 

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MDS Changes Countdown – Day 9

COUNTDOWN DAY 9: Resident Interviews

In long-term care, the voice of the resident is invaluable. As the Minimum Data Set (MDS) evolves, it places increasing emphasis on resident input, particularly through interview-based questions. In the MDS 3.0 v.1.18.11, there are a total of twenty-one resident interview questionnaires (e.g., mood, preferences, pain). 

To provide the best possible care, accurate information is paramount. While medical assessments and charts are essential, self-report from the resident remains the single most reliable indicator of their well-being. Residents possess a wealth of knowledge about their own lives, preferences, and needs. Interviewing residents provides an opportunity to tap into this knowledge. By doing so, we gain insight into what they consider to be the most important facets of their lives. This knowledge forms the foundation for person-centered care and prioritizes individual preferences and choices. 

To ensure open communication in a supportive care environment, consider the following tips for a successful resident interview.

  • Introduce yourself to the resident.
  • Be sure the resident can hear what you are saying.
  • Ask whether the resident would like an interpreter.
  • Find a quiet, private area where you are not likely to be interrupted or overheard.
  • Ask the questions as they appear in the questionnaire.
  • Repeat the response options as needed.
  • Use cue cards as appropriate.
  • Move on to another question if the resident is unable to answer.
  • Break up the interview if the resident becomes tired.
  • Record the resident’s response, not what you believe they should have said.
  • If the resident becomes deeply sorrowful or agitated, sympathetically respond to their feelings.

In the ever-evolving landscape of long-term care, the resident interview has gained increasing importance. By placing residents at the center of decision-making and fostering a supportive care environment, we can truly honor their preferences and choices.

Be on the lookout for tomorrow’s blog: Social Determinants of Health. 

In case you missed yesterday’s blog, click to review: Know Your Resources.

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MDS Changes Countdown – Day 10

October 1 is 10 business days away, and with that date brings the long-awaited revisions to the minimum data set (MDS). Understanding these changes and their broad implications is crucial. Equally important is the efficient training of your staff for seamless implementation. Over the next 2 weeks, Reliant Rehabilitation will be sharing daily blog posts covering essential MDS updates, points to consider, and educational opportunities for staff including:
10. Know Your Resources
9. Resident Interviews
8. Social Determinants of Health
7. Additions, Modifications, and Clarifications
6. Section GG – Functional Abilities
5. Section D – Mood
4. Care Area Triggers & Care Area Assessments
3. Impact to State Case Mix
2. Quality Measure Impact
1. Interdisciplinary Collaboration

COUNTDOWN DAY 10: Know Your Resources
Foundational to any new learning is affirming that information is from a primary source of reference. For the MDS and RAI revisions, the primary source is CMS.
Each blog is developed by Reliant Rehabilitation’s team of RAC-Certified clinicians and contains easy to digest summaries of the MDS Updates.
Provided here is a compilation of CMS Websites, Training, and Manuals to download and bookmark as we embark on this blog series.

MDS 3.0 RAI Manual v1.18.11

MDS Item Sets v.1.18.11v5

CMS SNF 2023 Guidance Training Program

Monitor your email for updated information from Reliant including Real Time Memos, Reliant Reveal, and webinar trainings. To register for Reliant’s webinar on Effective Case Mix Management this Thursday, click HERE.

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Clinicians Who Inspire – Rhiannon Haynes, COTA/DOR – April 2023

This month we had the privilege of speaking with Rhiannon Haynes, COTA and DOR, Champion Level I, at Envive Healthcare of Hartford City, to share some insight and inspiration from clinicians in the field. As we discussed treatment interventions and interdisciplinary communication, it was evident that Rhiannon brings “good vibes only” everywhere she goes.

Rhiannon encourages therapists to have no fear in thinking outside the box, trying new things, and reaching out to colleagues when it comes to providing the best treatment for residents. She shared the importance of humor, positivity, and patient-centered goals to motivate residents to not only participate, but also enjoy their therapy sessions. Recently, the therapists at Hartford City have incorporated the use of ‘Alexa’ in their therapy gym. Whether it be to play music during exercise, practice communication skills with Q&A, or to catch up on the week’s weather forecast, it has proven to bring something extra to therapy. Rhiannon also shared that holiday groups to create crafts and door decorations help brighten the halls of their community.

The staff at Rhiannon’s facility share the common goal of being there for one another so that ultimately, they can be their best for their residents. She spoke of the interdisciplinary team as a “family unit” that values each person’s role in overall cohesion and communication. “We all talk to one another with openness and common respect. We treat each other how we want to be treated, and that makes it easy for good vibes.”

Rhiannon- thank you for sharing your good vibes with your residents, your “family unit”, and your therapy peers! You are an inspiration, and your care matters!

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HRSA Releases Updates Regarding Period 4 Reporting of COVID-19 Funds

Health Resources and Services Administration (HRSA) released two important updates: 

·         Reporting Period 4 (RP4): Providers who received one or more PRF (General or Targeted) and/or ARP Rural payments exceeding $10,000, in the aggregate, from July 1 to December 31, 2021, must now report on their use of funds. The PRF Reporting Portal opened for RP4 on January 1, 2023, and will remain open through March 31, 2023, at 11:59 p.m. ET. Additional HRSA guidance is available on the PRF Reporting Resources webpage.

·         Phase 4 and ARP Rural Payment Reconsiderations Deadline: Providers who believe their Phase 4 and/or ARP Rural payment was calculated incorrectly have an opportunity to submit a payment reconsideration within 45 days of receiving the notification for their company. For more information, visit the Payment Reconsideration webpage.

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SNF Provider Preview Reports Now Available

The Skilled Nursing Facility (SNF) Provider Preview Reports have been updated and are now available. These reports contain provider performance scores for quality measures, which will be published on Care Compare and Provider Data Catalog (PDC) during the April 2023 refresh.

 

The data contained within the Preview Reports are based on quality assessment data submitted by SNFs from Quarter 3, 2021 through Quarter 2, 2022. Additionally, the Centers for Disease Control and Prevention (CDC) COVID-19 Vaccination Coverage among Healthcare Personnel (HCP) measure reflects data from Quarter 2, 2022. The data for the claims-based measures will display data from Quarter 3, 2019 through Quarter 4, 2019 and Quarter 3, 2020 through Quarter 2, 2021 for this refresh, and for the SNF Healthcare-Associated Infections (HAI) measure, from Quarter 4, 2020 through Quarter 3, 2021.

 

Providers have until February 16, 2023, to review their performance data. 

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Promoting Mental Health in Long-Term Care

The month of January hosts National Popcorn Day and National Compliment Day among other lighthearted celebrations; however, it is also known to be Mental Wellness month. Before this month comes to an end, let’s take some time to discuss the importance of mental health awareness in long-term care and evaluate current efforts in place to promote mental wellness.

According to a study published by the National Institutes of Health, 65-90% of nursing home residents are affected by a mental health disorder. Furthermore, research tells us that decreased mental health can affect both cognitive and physical functioning, and ultimately, a resident’s quality of life. With this knowledge, it’s not surprising that the Centers for Medicare and Medicaid Services (CMS) recently updated requirements and compliance processes related to mental health services in the long-term care setting. Awareness of the effects of mental health on residents is imperative, but only one piece of the puzzle in the greater picture of optimized mental wellness. Focus on facility processes that facilitate opportunities for residents to feel like their best selves is a key component to success.

Listed below are some practical ways for skilled nursing facilities to promote mental wellness among residents:

  • Maintain connection with friends and family. Provide accessibility to necessary devices for planning and interaction.
  • Increase opportunities for decision-making. Offer choices in meal options, leisure activities, and daily routine.
  • Provide activities to promote physical and mental exercise. Encourage residents to safely participate in memory games, puzzles, and home exercise programs.
  • Encourage social interaction through group activities. Ensure every resident is invited to attend celebrations, group activities, and/or community outings.
  • Implement resident-specific interests in daily life. Promote facility staff awareness of each resident’s motivation and activities of interest.

Reliant strives to serve with you to promote the mental health of residents in your facility. Reach out to your Reliant partners to learn more.

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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.

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Speech Language Pathology’s Role in COVID Recovery

The novel coronavirus and resulting pandemic have altered our lives in many ways. The combination of  isolation, physical and social distancing, as well as an economic crisis have all impacted our personal and professional lives. Juggling the ever-changing responsibilities during a healthcare emergency may be overwhelming. The lack of social connections with family and friends as well as in-person visits with your patients can lead clinicians to feelings of loneliness and isolation. Now consider the impact that continued social distancing and isolation may have on the residents and patients within our long-term care facilities. In some instances, isolation of residents has been ongoing for the entirety of the pandemic, entering nearly 6 months!

Prior to this healthcare emergency, a 2019 University of Michigan study on healthy aging noted that 34% of adults aged 50-80 years reported feeling lonely. This current period of social isolation will only exacerbate the number of adults feeling disconnected and lonely and disproportionately affect the elderly population, especially those whose primary social contacts were within their long-term care facility. Furthermore, according to the National Academics of Sciences, Engineering, and Medicine, “Seniors who are experiencing social isolation or loneliness may face a higher risk for mortality, heart disease, and depression.”

As experts on communication, SLPs know the value and need for social interaction for the mental health and well-being of our patients. We are a major factor in the identification of patient needs and educating patients and caregivers on appropriate and personalized techniques to improve and maintain cognitive, speech-language, and executive functioning. We can start by educating on the importance of social interaction and modeling how to achieve this safely during the pandemic.

In the absence of cognitive stimulation and routine, patients may have trouble maintaining prior levels of cognition. We can encourage and educate on the use of daily orientation techniques and maintaining daily routines – targeting problem solving, reasoning, memory, and sequencing during morning and evening self-care routines. Engage with each patient on a personal level and encourage all caregivers to do the same. Provide insight to caregivers on personal preferences that may enhance engagement.

Socialization and purpose play a critical role in feelings of self-worth and success in everyday life. Encourage the use of personal electronic devices. Provide education on increasing socialization through communication and social media. Encourage residents to write letters to family or “neighbors” within the facility. Foster conversation between residents and caregivers during meals and invite family or friends to “dine” with residents via videoconferencing.

Incorporate training on personalized “home” exercise programs to give purpose and focus to each resident’s day. Develop exercises that capitalize on the routines the resident has already established, such as oral motor exercises and/or breathing exercises during a TV commercial break.

As we evolve as professionals during a pandemic, we must continue to protect and advocate for our most vulnerable residents. With the continuation of the healthcare emergency there is a fine line between protecting those that are medically fragile from this virus while continuing to encourage and promote socialization that is vital to their well-being. As visitor restrictions are lessened we continue to be the lifeline that can bring awareness to the effects of social isolation on our residents in long-term care, and by supporting the facility and promoting each caregivers’ strengths as well as educating in areas of opportunity we are creating a more understanding and supportive environment for our residents.  

https://www.asha.org/Practice/Connecting-Audiologists-and-Speech-Language-Pathologists-With-Mental-Health-Resources/

https://time.com/5833681/loneliness-covid-19/

The Costs of Social Isolation: Loneliness and COVID-19

https://www.nationalacademies.org/news/2020/02/health-care-system-underused-in-addressing-social-isolation-loneliness-among-seniors-says-new-report

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Occupational Therapy’s Role in COVID Recovery

As we all have become acutely aware of, COVID-19 and the response to the pandemic have resulted in adverse outcomes to residents of skilled nursing and long-term care facilities. These adverse outcomes range from reduced physical function, including decreased muscle strength and endurance, to cognitive and psychosocial impairments, including delirium, neurological dysfunction, depression, and occupational deprivation. In combination, these symptoms paint a clear picture for the need of occupational therapy (OT) intervention. As OT practitioners, we must identify and champion our unique role in not only the physical rehabilitation of our patients but also in their psychological well-being.

According to the American Journal of Occupational Therapy’s (AJOT) OT Practice Framework, our profession, in its fullest sense, is facilitating achieved “health, well-being, and participation in life through engagement in occupation.” We identify the areas of occupation that our residents value, consider their context, and recognize the unique performance patterns and skills that affect the individual’s ability to engage and participate. This is clearly a client-centered, holistic process—one that considers physical function, cognition, and psychosocial impairments that may be impacted. Who better to address the wide range of outcomes that have resulted with our residents in skilled nursing and long-term care facilities?

As we continue to care for our residents who have been affected directly or indirectly by COVID-19, it is imperative that we implement this client-centered, holistic approach. How has the individual’s physical function been affected? Consider implementation of a cardiopulmonary program that includes respiratory strategies, postural control exercises, and exercise prescriptions. To address changes in cognition, complete a standardized cognitive assessment to identify specific processing skills for intervention during activities of daily living. Equally important, and even more important in some cases, are the psychosocial challenges that residents face during the pandemic. As patients are isolated to reduce transmission risks, unintended negative consequences present, including disruption of daily routines and restrictions to leisure and social participation. Recent studies suggest that isolation- associated loneliness has contributed to swift health declines in residents with dementia during the COVID-19 pandemic. Recognize and affirm residents in the challenges they face and use creative technological outlets to enhance participation in meaningful daily activities. Are there opportunities for virtual conferencing with friends or family? Are audio books, online games, or learning modules an option for leisure?

As OT practitioners, we are equipped to meet the tidal wave of challenges that COVID-19 has introduced to residents in skilled nursing and long-term care facilities. The tenets of our profession prepare us to respond to the physical, cognitive, and psychosocial changes that may occur. Though relaxed restrictions to nursing home visitation are on the horizon, the time is now to take hold of our unique, distinct role in facilitating health, well-being and participation in the lives of our residents.   

References:

American Occupational Therapy Association. (in press). Occupational therapy practice framework:

Domain and process (4th ed.). American Journal of Occupational Therapy, 74 (Supplement 2). Advance online publication.


De Biase, S., Cook, L., Skelton, D. A., Witham, M., & Ten Hove, R. (2020). The COVID-19 rehabilitation

pandemic1. Age and ageing, 49(5), 696–700. https://doi.org/10.1093/ageing/afaa118

Gitlow, L., PhD, ATP, FAOTA, OTR/L, Lee, S., OTR/L, Hemraj, R., OTR/L, Sheehan, L., OTD, OTR/L, & Ambroze, G., OTS. (2020). Occupational Therapy and Older Adults: Combating Social Isolation through Technology. PDF. American Occupational Therapy Association.

Lasek, A. (2020, September 18). Dementia mortality skyrockets since lockdowns; CMS loosens visitor restrictions – Clinical Daily News. Retrieved September 18, 2020, from https://www.mcknights.com/news/clinical-news/dementia-mortality-skyrockets-since-lockdowns-cms-loosens-visitor-restrictions/?utm_source=newsletter

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Physical Therapy’s Role in COVID Recovery

For over 100 years, physical therapists have specialized in human movement using skilled interventions to maximize health and function.  During periods of critical illness, such as moderate to severe cases of COVID-19, it is common for patients to experience a loss of physical function which can lead to the development of new impairments or worsening of existing ones.

Long-term recovery from COVID-19 may be complicated by lasting effects due to deconditioning, restrictive lung disease, post intensive care syndrome, or neurological disorders. After 10 days of bed rest healthy older adults may lose up to 2.2 pounds of muscle mass from the legs with 2-5%/day loss of muscle strength.  Recovery of physical function may take an extended period of time with impairments that may persist up to 2 years post infection. 

As practitioners of movement, physical therapists are essential in early mobility during and following a critical illness in order to minimize the effects of immobility.  Through skilled interventions such as functional mobility, balance training, endurance activities, posture training, and strengthening, physical therapists are equipped to help residents achieve their optimal level of function as quickly and effectively as possible.

Along with debility, residents in nursing homes that remain quarantined during the public health emergency face another silent threat: social isolation. Even with the recent relaxation of nursing home visitor guidelines, the effects of social isolation may be long lasting.

Restricted access to family and friends may affect even those who have not contracted the virus itself and may include severe fatigue, anxiety, post-traumatic stress disorder, depression, and cognitive dysfunction. 

The effects of patients remaining in their room, the cessation of communal dining, and restricted access to common areas (i.e. the therapy gym and equipment) pose significant barriers not only to successful intervention and outcomes, but also overall resident well-being. The interdisciplinary team should assess and re-assess situations, analyze tasks, make changes, and consider a holistic plan of care to help reduce the lasting effects of social isolation and provide person-centered, specialized care which emulates Reliant’s motto of Care Matters.

References:

https://www.bsrm.org.uk/downloads/covid-19bsrmissue1-published-27-4-2020.pdf.

https://academic.oup.com/ptj/article/100/9/1458/5862054

https://www.aannet.org/initiatives/choosing-wisely/immobility-ambulation

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Breast Cancer Awareness Month Activities

Most people know someone who has been diagnosed with breast cancer. This month, we remember those brave individuals we’ve lost and send lots of healing thoughts to those who still are fighting. Here are some ways you can foster a community of support to those women—and men—and their families.

Pink Pumpkins Why not!?

Organize a simple activity to have residents, patients, employees and family members paint or decorate mini-pumpkins in pink to spread awareness—and cheer—throughout residential and therapy areas.

Wear Pink

Raise awareness in the community by asking everyone to wear pink for a day or a week to remember, support and advocate for breast cancer awareness.

Host a Support Group

Work with a local oncologist and host a support group or event for women battling breast cancer to connect with each other, share their stories and offer support.

Hold a Hat & Scarf Drive

Collect or make hats or scarves to donate for women who are going through chemotherapy at a local center.

Support Prevention Programs

Host an information session with one of the community nurses, physicians or nurse practitioners to talk about how to do self exams and the importance of regular mammograms to catch breast cancer early enough for effective treatment.

Aging and Mammography

We’re living longer than ever. The median life expectancy for an 80 year old woman is nine years, so if you’re generally healthy, it can make sense to continue screening through the 70s and perhaps early 80s. As the American Cancer Society recommends, “Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or longer.”