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.

Coronavirus Scams, A Year Later…

This time last year, increased reports of scams and phishing attempts referencing COVID-19 captured our attention causing us to be vigilant to protect our businesses and patient information.

Fast forwarding to this year, many states have begun to lift COVID-19 restrictions, but the bad actor’s scams and phishing attempts have not let up. They continue their tactics to entice us through scams and/or phishing attempts.

Many times these attacks appear as innocent emails seeking assistance or providing information regarding the COVID-19 crisis. Bad actors are taking advantage of this crisis to prosper or do damage.  Their criminal actions are becoming increasingly sophisticated and look very official, as if coming from government agencies and health organizations.

Today and always, let us remember, it is critical to continue vigilance with all email correspondence and access to websites, but particularly those referencing COVID-19 updates, maps, donations, notifications etc.

To avoid becoming a victim, follow the guidelines below:

  • Never click on links or open attachments within unexpected emails.
  • If you receive a suspicious email appearing to come from a legitimate organization such as CDC, WHO, FEMA etc., confirm its legitimacy.  Make sure links direct you to the official site by hovering over the link.  Report suspicious email to your company’s Information Security Department.
  • If you visit a website or receive a pop-up window directing you to a phone number for support desk assistance, DO NOT call the number, instead contact your company’s Information Security Department.
  • Never share your password with anyone.

Continued trends noted to date include:

  • Malicious websites – sites referencing coronavirus or COVID-19 in the URL. Thousands of new websites have recently been registered to distribute malware when the user accesses the site.
  • Spam – emails trying to grab your attention to sell information or goods now in high demand such as masks, hand sanitizers, COVID-19 drugs, etc.
  • Phishing – emails posing to be from legitimate organizations such as the Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO), the Federal Emergency Management Agency (FEMA), etc. These emails contain malicious links, and some are collecting personal information.
  • Fake charities – emails and websites asking for donations for studies, healthcare professionals, victims, or other activities related to COVID-19.
  • Fake internal HR or IT communications such as coronavirus surveys pretending to be from your company’s HR or IT department – these sites are attempting to obtain your User ID and password or other personal information.
  • Fake notification of infection – beware of emails reporting you have been exposed to an infected individual, particularly ones asking for personal information to proceed.

 Always Think Before You Click.

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/.

Spring Into Motion: Ideas to Encourage Resident Mobility

Social isolation resulting from the health care emergency is directly correlated with reduced everyday activity, which in turn leads to decreased mobility and independence for our residents. Mobility is an essential component of quality of life; the loss of opportunities for mobility can lead to undesirable health outcomes such as skin integrity issues, musculoskeletal disorder exacerbation, increased pain, pneumonia, circulatory problems, incontinence, debility, depression, and increased risk of falls.


The benefits of movement and mobility have long been researched and proven to stimulate circulation, increase joint flexibility, prevent contractures, strengthen muscles, improve self-esteem and feelings of independence, facilitate the resident’s ability to socialize, and even stimulate appetite. There are endless opportunities to encourage increased movement to foster improved quality of life and ultimately allow for happier, more independent residents.

Helpful tips to get residents moving:
• Offer walk to dine as safely allowable. Increasingly encourage the “long route” to the dining room.
• Play residents’ favorite music throughout the day and encourage mobility through dance.
• Engage balance while making the bed as part of the normal morning routine.
• Encourage exercises such as sit to stand during TV commercial breaks or every hour on the hour.
• Facilitate a game of balloon toss while sitting socially distant in a common area to increase upper body mobility and socialization.
• Promote stretching to maintain or increase flexibility—urge residents to reach further with each attempt. Stretching can be integrated into daily self-care routines!
• Challenge fine/gross motor coordination while performing resident-driven activities such as crafts, writing letters to family, gardening, or other leisure activities.
• Create simple scavenger hunts within the facility or in the resident’s room. With Easter just around the corner, consider organizing an Easter egg hunt!
• Provide health literacy on the risk of reduced mobility, the importance of exercise routines and sitting upright throughout the day.
• Encourage a daily routine of fully dressing and grooming to increase out of bed (out of room as able) activity throughout the day.
• Enlist family member support when available. Have them join the resident virtually for exercise, dancing, or leisure activities.
• Refer to physical therapy and/or occupational therapy when safe mobility is a concern.

The public health emergency continues to introduce unique considerations related to social isolation; however, communities are continually showing a steadfast ability to work together to meet residents’ needs. Through interdisciplinary communication all can be advocates for increased mobility and socialization opportunities for each resident, which will lead to improved physical and mental well-being. It takes each member of the team to offer insight to devise the perfect care plan that will lead to positive patient outcomes. By working together, mobility will continue to bloom through the pandemic and beyond!

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!

Roll Up, Reliant!

We all hope to see, sometime in the near future, a resumption of normalcy where we can walk in and out of our facilities without masks and PPE, where we can visit with family members freely and give our elderly loved ones tight hugs and pecks on the cheek.  With the COVID-19 vaccine rollout, this hope is that much closer to becoming a reality.

Even though we have this glimmer of hope with the production of the vaccine, that is only the first step.  It is now a matter of distributing, administering, and educating.  There is fear, anxiety, and uncertainty regarding the vaccine, therefore, educating our healthcare professionals and residents on the safety and benefits of the COVID-19 vaccine is paramount.  

Our long-term care residents and healthcare frontline workers are among the first to have the opportunity to be vaccinated. While the latest statistics show a very high participation rate among residents, they also show that a large number of healthcare workers are shying away from rolling up their sleeve.  As healthcare workers, we are some of the most trusted individuals and often provide a sense of comfort to everyone else looking for guidance in such a time of unknown.  Getting vaccinated may not only protect you, but your loved ones, and those at high risk, including our beloved long-term care residents.

Reliant has been proactive in vaccination awareness for our therapists. This includes sharing peer vaccination stories and posting a series of videos by Dr. David Gifford, AHCA/CCAL, addressing important questions about the COVID-19 vaccine.  If you have not had a chance to watch them and want to hear some pressing questions answered, take a few minutes and click on the links below.

 Why Should I Get the COVID-19 Vaccine?

Does the COVID-19 Vaccine Cause Allergic Reactions?

What are the Side Effects of the COVID-19 Vaccine?

​​How Was the COVID-19 Vaccine Developed So Quickly?

Will the COVID-19 Vaccine Cause Infertility​?

Why Should I Get the COVID-19 Vaccine Now When I Can Wait to See What Happens? ​

Get informed and let’s ROLL UP, Reliant!

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. 

The Top 7 Health Benefits of Gratitude

It’s been said that the two most powerful words in the English language are “Thank You.” But did you know that adopting an attitude of gratitude also can have a tangible, positive impact on your health? Here are some ways being grateful can boost your spirit and contribute to your overall quality of life.

  1. Lower Blood Pressure. In a 2007 study, researchers found that people were instructed to “count their blessings” once a week showed a significant decrease in their systolic blood pressure.
  2. Lower Risk of Depression. According to Sanam Hafeez, M.D., gratitude reminds us that not everything in our lives is bad and can give us motivation and a sense of hope that can protect us from feelings of depression.
  3. Better Sleep. In a research project of 65 people with chronic pain, those who were assigned a daily gratitude journal assignment reported a half an hour more sleep than those who were not. In other studies, the discipline of gratitude has caused people to report a faster time to sleep, improved sleep quality and more alertness during the day.
  4. Reduces Stress. Because gratitude activates the parasympathetic nervous system, it can stave off stress which has very well-known destructive health implications.
  5. Increased Energy. Multiple studies have correlated vitality and gratitude, and because gratitude increases physical and mental well-being, it can lead to increased energy levels.
  6. Improved Self Care. Grateful people are more likely to exercise and take care of their health according to a 2012 study. They are more likely to have regular check-ups and take precautions to improve their health.
  7. Boost Mental Strength. For people who have experienced traumatic events, gratitude has been shown to help buffer the long-term impact of that trauma and can lead to much greater resilience.

Celebrating a Diabetic-Friendly Thanksgiving

November is American Diabetes Month, and this week, we may have an opportunity to see loved ones either in person or virtually to celebrate the Thanksgiving holiday. We’ve put together a few diabetic-friendly Thanksgiving recipes in a downloadable cookbook that you can use this week for you.

While many patients and residents may have a clinical diagnosis for Type II Diabetes, there are some clinical presentation characteristics that can help us identify those who may be undiagnosed.

•          Increased thirst

•          Frequent urination

•          Extreme hunger

•          Blurred vision

•          Fatigue

•          Unexplained weight loss

•          Slow-healing sores

•          Tingling, burning, or numbness in feet and hands

•          Pain in joints or muscles

•          Frequent infections

•          Diabetic ketoacidosis

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)

Care Matters Spotlight October 2020

Mr. Borden admitted to Holzer Senior Care Center with the ultimate goal of returning home with his wife. Upon admission, Mr. Borden required the use of a feeding tube for nutrition and a mechanical lift to complete transfers. At first, returning home with his wife seemed like a lofty task due to the amount of assistance Mr. Borden needed.  He soon became unmotivated and thought this goal was impossible due to apparently insurmountable tasks.  Both he and his wife thought that he would be staying at the facility forever.

In the midst of this, Mr. Borden had a brief readmittance to the hospital and then returned to Holzer Senior Care Center with a new outlook and motivation.  After putting his all into and excelling in an aggressive therapy program tailored to meet his needs, Mr. Borden began eating regular food and was able to walk out of Holzer Senior Care following his intensive program.  What a great testament not only to Mr. Borden, but also to the excellent therapists and staff at Holzer Senior Care Center!

Mr. Borden’s ultimate goal was met; he was able to return home with his wife. Mr. Borden is pictured here, with his PT and OT, heading to embrace his wife after months of being separated from each other.  The staff, Mr. Borden, and his wife had a “going home” parade and sang “O Happy Day” as Mr. Borden walked to the car.  Needless to say, it was an emotional day for everyone as the Bordens hugged each other for the first time in 4 long months!

Great job Mr. Borden and awesome job, team!

Moving Forward: Safe and Successful Reintegration

In September, the Centers for Medicare and Medicaid Services (CMS) released exciting news for the advancement of safe visitation and resumption of group activities and communal dining in nursing homes (see QSO-20-39-NH). As the effects of isolation have taken a tremendous toll on our elderly population, care teams and residents are ready to implement safe steps to social reintegration.  Facilities, including therapy departments, can now offer a variety of group activities while also taking the necessary precautions.

CMS provides Core Principles of COVID-19 Infection Prevention which should be incorporated as best practice to reduce the risk of COVID-19 transmission in order to resume visitation and group activities. It is indicated that group activities may be facilitated (for residents who have fully recovered from COVID-19 and for those not in isolation for observation, suspected or confirmed COVID-19 status) with social distancing among residents, appropriate hand hygiene, and use of cloth face coverings or facemasks. CMS’ examples of group activities include book clubs, crafts, movies, exercise and bingo.

As facilities implement these principles and activities, it is important to remember, early in the pandemic, resident-centered care plans were adapted for isolation considerations. These care plans should now be reviewed, especially in the light of infection control prevention, trauma-informed care, cognitive changes and fall prevention. It should not be assumed that residents will function at the same level as they did pre-pandemic; therefore, consider the increased risks associated with the possible secondary effects of the pandemic and isolation precautions:

  • Infection Prevention and Control: Review the resident’s ability to safely wear cloth face coverings and understanding of or cueing needed for social distancing. Identify assistance and reminders needed to perform hand hygiene.
  • Trauma-Informed Care (TIC): Consider whether the resident is suffering from anxiety associated with infection risk or recovery and provide a facility plan for safe reopening. Ensure staff buy-in to the plan and implementation in order to set good examples and provide TIC support. Be sensitive to the effects of a busy, potentially noisy, environment following a period of social isolation.
  • Cognitive changes: As social interaction increases and the physical environment changes, be aware of behavioral responses and signs or symptoms of confusion. Assess behaviors as a form of communicative response to the environment and adapt as appropriate.
  • Fall prevention: Consider that as the resident’s access to the facility and grounds expands, their environment is now exponentially larger. Review their ability to safely ambulate throughout the facility as this may place the resident at increased risk of falls and wayfinding confusion.

Protecting residents from COVID-19 highlights the struggle between keeping residents healthy and providing beneficial, daily experiences that can impact quality of life. Nursing, therapy, and facility staff must work as a team to implement creative means to facilitate safety during group activities and social reintegration to allow our residents to safely flourish in light of the challenges they encounter.

PHI Breaches and Breach Reporting

What is a breach of Protected Health Information (PHI)?  A breach means the impermissible acquisition, access, use, or disclosure of PHI as defined under the Health Information Portability and Accountability Act (HIPAA) Privacy Rule that compromises the security or privacy of PHI.

Whenever a breach of PHI occurs, the residents impacted must be notified along with the secretary of the United States Department of Health and Human Services (HHS).  Residents must be notified as soon as possible but no later than 60 days from discovery of the breach.  This notification deadline to the Secretary of HHS varies depending on the number of residents impacted.  If less than 500 residents are impacted, the deadline for notification to the Secretary is 60 days after the end of the calendar year in which the breach occurred.  If 500 or more residents are impacted, the deadline for notification to the Secretary is no later than 60 days from the discovery of the breach. 

Covered entities are required to report breaches to the Office of Civil Rights Breach reporting portal. The United States Department of Health and Human Services, in accordance with section 13402(e)(4) of the Health Information Technology for Economic and Clinical Health Act (HITECH), posts online a list of breaches impacting 500 or more individuals.  This breach portal is unofficially labeled the “Wall of Shame”.  CLICK HERE to visit the portal.

Interrupted Stay Policy

Under the Patient-Driven Payment Model (PDPM), there is a potential incentive for providers to discharge skilled nursing facility (SNF) patients from a covered Part A stay then readmit the patient in order to reset the variable per diem schedule. To mitigate this potential incentive, an interrupted stay policy is included within the PDPM. 

This policy combines multiple SNF stays into one single episode in situations where the patient’s discharge and readmission occur within a prescribed window. If a patient is discharged from a SNF and readmitted to the same SNF no more than three consecutive calendar days after discharge, then the subsequent stay is considered a continuation of the previous stay.  In this instance, the variable per diem schedule continues from the point just prior to discharge.

If the patient is discharged from a SNF and then readmitted more than three consecutive calendar days after discharge or admitted to a different SNF, then the subsequent stay is considered a new stay.  In this instance, the variable per diem schedule resets to day one.

CLICK HERE for more information in the PEPPER User’s Guide Update.

CMS Memo on the Resident’s Right to Vote

The Centers for Medicare & Medicaid Services (CMS) released a memo reiterating the continued right of nursing home residents to exercise their right to vote. While the COVID-19 Public Health Emergency has resulted in limitations for visitors to enter the facility to assist residents, nursing homes must still ensure residents are able to exercise their Constitutional right to vote.  A resident’s rights, including the right to vote, must not be impeded in any way by the nursing home staff. 

Nursing home personnel should have a plan to ensure residents can exercise their right to vote, whether in person, by mail, absentee, or other authorized process. For residents who are otherwise unable to cast their ballots in person, nursing home staff must ensure residents have the right to receive and send their ballots via the U.S. Postal Service or other authorized mechanism allowed by the State or locality.

CLICK HERE to read the full memo from CMS.