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.

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. 

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.

Clinicians Who Inspire – January 2023 – Karla Ashley

Through the Clinicians Who Inspire series, we continue to share motivation, creativity, and inspiration from clinicians in the field. This month we spoke with Karla Ashley, Champion Level I Therapist, occupational therapist and Director of Rehab at Vicksburg Convalescent Home. Through facilitation of resident opportunities for social interaction and participation in activities that stimulate the mind, body and spirit, Karla finds meaning in her every day as a therapist in the skilled nursing facility.

During the interview, Karla discussed some of the fun group therapy activity ideas they have implemented recently at their facility. Dancing groups, indoor/outdoor gardening activities, and an annual Mardi Gras parade—complete with beads, masks, pies, and a king and queen, are just a few of the examples provided. She shared the many benefits and positive outcomes they’ve seen through these groups, including improved balance, coordination, cognition, and morale amongst participants.

Karla shared that though she has worked in various settings throughout her 30-year career, she loves working in the skilled nursing facility setting. “The residents become your family. You’re there with them through it all. Even those that come and go; they come back to us when they need it. They come to love and respect us as much as we love and respect their needs.” Thank you, Karla, for sharing your passion and creativity with your patients, interdisciplinary team, and therapy peers!

Clinicians Who Inspire – December 2022 – Hensen Keetch

Through the Clinicians Who Inspire series, we continue to share motivation, creativity, and inspiration from clinicians in the field. This month we spoke with Hensen Keetch, Champion Level II therapist and physical therapist at Canyon Rim Care Center. Through creativity and recognizing each patient’s individuality, he continues to have an impact in meaningful ways.

During the interview with Hensen, it was noted that he has a deep understanding of person-centered care and brings that into his daily treatment interventions. During group activities, Hensen and the other group participants learned that one patient previously played basketball overseas and another patient was the scorekeeper for the local NBA team. These discoveries led to additional activities, discussions, and connections within groups. He also shared an example of a patient who was a former high school soccer player.  With this knowledge, the team intertwined soccer into treatment; what better way to challenge balance than with passion for the game?  

Hensen knows that interdisciplinary team communication and education are keys to patient success. As an advocate for fall prevention and intervention, he meets with the nursing staff to discuss individualized strategies and plans for fall reduction and recovery after every reported fall. 

Hensen, thank you being a clinician who inspires your patients, the interdisciplinary team, and your therapy peers! 

Clinicians Who Inspire – November 2022 Kristin Jacobson-Messner

Through the Clinicians Who Inspire series, we continue to share motivation, creativity, and inspiration from clinicians in the field. This month we spoke with Kristin Jacobson-Messner, Champion Level I Therapist, SLP and Director of Rehab at Avalon Health Care in Madera. Through her creativity and positive outlook, she continues to have an impact in meaningful ways.

Through creating colorful, personalized memory books; incorporating seasonal treats during dysphagia treatments (e.g., pumpkin pie), or decorating the gym, Kristin strives to keep her interventions person-centered. She also credits the entire team at the facility for having a united attitude when it comes to caring for the residents. Oftentimes, the activities team will collaborate and work with the rehab team to continue with tasks and exercises residents have achieved in therapy, helping to carryover functional gains and compensatory strategies.

For personal growth in her field, Kristin really enjoys participating in CEUs offered through Reliant U. Her favorites are those focused on dysphagia.

Thank you, Kristin and team, for fostering friendships, teamwork, creativity and innovation; and for being clinicians who inspire each other, your patients, and all your therapy peers! 

Clinicians Who Inspire – October 2022 Laura Redd, COTA

Through the Clinicians Who Inspire series, we continue to share motivation, creativity, and inspiration from clinicians in the field. This month we spoke with Laura Redd, COTA/Director of Rehabilitation and Champion Level II therapist at Huntsville Health Care Center. During the interview, she explained that she has always worked in skilled nursing. She was originally employed as a CNA, then worked as a rehabilitation tech for seven years before becoming a COTA and then Director of Rehabilitation. Her unique background has provided insight into how to bridge the gap of communication between therapy and nursing.

Laura is passionate about ensuring patients have as many opportunities as possible for out-of-bed engagement. As a Champion Level II therapist, she provided education to nursing staff concerning the need for residents to be out of bed, not only for therapy, but also for meals and activities as the research supports out of bed activities improve overall wellbeing and quality of life. Her presentation was used to develop a resource for Reliant about the benefits of social interaction and physical activity, click HERE for a glimpse at this resource. She indicated that once all staff understand that the purpose of the patient being out of bed and engaged is “to maintain their functional level and prevent declines”, it becomes ultimately easier for everyone to work toward that goal.

Laura, thank you for all you do for your residents and nursing teammates, advocating for quality patient care, and for being a clinician who inspires your patients and your peers! 

Clinicians Who Inspire – October 2022 Daisy Franklin, PT

When Daisy Franklin, PT, started her career 17 years ago, she was sure pediatrics was the setting for her. That is, until a friend referred her to a SNF, where she took the job and has been at her current facility now for 15 years. Daisy loves her residents and truly enjoys hearing their life experiences while gaining knowledge from them daily.

As DOR and part of the therapy team, Daisy interacts with all facility staff and says they are like one big family. She and most of her co-workers have been in this facility for 5+ years which supports that feeling of family; they have been through a lot together.  

Fun isn’t just reserved for the therapists; Daisy and her co-workers enjoy making therapy fun for the residents too! The residents look forward to the cooking groups hosted by multiple disciplines. Daisy has personally witnessed the benefits group therapy has to offer, including increased socialization and increased peer interaction and support to encourage residents to do their best.

Daisy has achieved Champion Level 1 focusing on wound care. Climbing the Clinical Ladder has allowed her the opportunity to partner with the facility’s wound care physician to address wounds and accelerate the healing process with modalities. After achieving Champion Level 1, Daisy encouraged her peer therapists to pursue their own Clinical Ladder achievements. Daisy hopes to be able to see the whole rehab team ascend the Clinical Ladder and equip them with a plethora of knowledge to treat their patients.

If Daisy had to offer advice to her fellow therapists, she said it would be to practice patience and compassion in conjunction with their professional skills. Daisy, and team, thank you for all do for your residents and fellow therapists. You truly are an inspiration!

A Recipe for Success

Annual regulatory updates from CMS come as no surprise; however, when coupled with significant updates from the CDC we may feel overwhelmed.

Successful implementation of regulatory, survey, federal, and state updates is possible when we implement the following strategies.

  1. BREATHE! – You’re not alone, and change does not have to be a bad thing. As a matter of fact, the new CDC and CMS guidance is leading us into a highly anticipated phase of the pandemic… a new beginning for our patients, visitors, and employees.
  2. Subscribe to CMS and CDC websites to receive fact sheets, FAQs, invites to webinars, and the latest updates.
  3. Know your company structure and departments of expertise. Watch for their guidance and recommendations.
  4. Review policies and procedures to ensure they are compliant with the new guidance.
  5. Consider any information that may need to be communicated to residents, families, and visitors (e.g., updated visitation guidance) and the best method to deliver this information (e.g., posting signage).
  6. Communicate with staff; consider various methods of delivery (email, webinars, in-person meetings).
  7. Assess the effectiveness of your facility’s implementation of new guidance and regulations. For areas needing improvement, make a plan to ensure preparedness.
  8. Connect with Reliant to receive Real Time Memos and the monthly Reliant Reveal newsletter.

In case you missed these recent publications from Reliant, click the links below to review our summaries of recently updated and upcoming regulatory guidance:

Clinicians Who Inspire – August 2022 Cheri Shefler, SLP/DOR

Through the Clinicians Who Inspire series, we continue to share motivation, creativity, and inspiration from clinicians in the field. This month we spoke with Cheri Shefler, Champion Level I Therapist, SLP and Director of Rehab at Willow Springs Rehabilitation and Healthcare Center. Cheri points out that it is important to have a positive environment where the therapy team and the facility staff can share a true camaraderie in order to facilitate a team approach in their patients’ care. She enjoys being a positive spirit and cheerleader for her colleagues.

Cheri explains that it is also important to have time together as a team. Food often wins the heart, so ordering lunch in or bringing favorite dishes to a holiday potluck are a few favorite ways they celebrate and grow as a team.

To fill her own cup, Cheri finds it rewarding to supervise and guide newly graduated SLPs in their Clinical Fellowship Year (CFY), especially those with little to no experience in the skilled nursing setting. She enjoys the fresh ideas and activities that the new and upcoming SLPs bring to the table and also guiding them to develop treatment interventions that are appropriate for each of their patients.

As opportunities open back up, Cheri looks forward to engaging team members and residents in Carnival Day! This day involves setting up carnival activities within the rehab gym and encouraging all patients and caregivers to participate in the fun, including group activities like tossing water balloons. Thank you, Cheri and team, for being clinicians who inspire each other, your patients, and all your therapy peers!

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.

Clinicians Who Inspire – July 2022 Lynne Steeber

Clinicians Who Inspire

Through the Clinicians Who Inspire series, we continue to share motivation, creativity, and inspiration from clinicians in the field. This month we spoke with Lynne Steeber, Champion Level I Therapist, OTR/L and Director of Rehabilitation at Majestic Care of New Haven. Lynne shared that being organized, keeping a goal-oriented mindset, and providing positive feedback to those around her are ways in which she finds success. Lynne touched on what some of the benefits of this communication have looked like at her site, recognizing the importance of being able to work together to identify and meet patient needs to promote their quality of life. She also discussed the importance of open communication and availability to support the facility staff, whether that be to discuss a noted change in a patient, or provide assistance or training, when needed. Thank you, Lynne, for sharing your positive energy with those around you and ensuring that patients receive the care that they need.  

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

Clinicians Who Inspire – June 2022 Alaynna Hebert Savoy

Through the Clinicians Who Inspire series, we continue to share motivation, creativity, and inspiration from clinicians in the field. This month we spoke with Alaynna Hebert Savoy, Director of Rehabilitation/PTA/Champion Level II therapist at New Iberia Manor South. Alaynna loves to incorporate music into therapy interventions. She explained interventions aren’t always going to be textbook. “You have to throw in fun stuff to keep your patient’s interest. Be flexible and creative.” Alaynna loves to work on dynamic reaching through dancing whether seated in a chair or in standing. She reports dancing to music always puts a smile on her patients’ faces. Alaynna also incorporates music in group interventions using a therapy ball to play “hot potato”. When the music stops, the person holding the ball has to do individualized exercises such as leg kicks or sit to stands. Her patients like group because it’s something different from individual therapy sessions. Alaynna also talked about the importance of positivity. She said “I try to make sure I’m happy. They don’t need to see someone with a sad face, they need to see me with a smiling face.” Thank you, Alaynna, for being creative, putting smiles on your patients’ faces, and inspiring your therapy peers.

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.

Clinicians Who Inspire – May 2022 Halen Coker

Through the Clinicians Who Inspire series, we continue to share motivation, creativity, and inspiration from clinicians in the field. This month we spoke with Halen Coker, DOR/SLP/Champion Level I Therapist at Pierremont Healthcare Center in Louisiana. Halen loves the added opportunities to communicate with family and caregivers in her role as DOR. As an SLP, she continues to expand her clinical skills by completing CEUs offered in Reliant University. She especially appreciates those courses targeting dysphagia and dementia. To target communication skills, Halen often plays various resident-preferred board and card games in a group setting. Recently, her focus has been on residents experiencing weight loss. She is working with the interdisciplinary team to brainstorm and utilize strategies to enhance the dining experience and improve mealtime intake. Halen attributes the positive vibes in the gym to the amazing team of clinicians she works with and their close collaboration. Not only do they continue to make the gym a fun and active place to be, but they also work to spread that positivity throughout the facility. She states, “this is their home, we have to make it happy.” Thank you, Halen and team, for being clinicians who inspire each other, your patients, and all your therapy peers!

Clinicians Who Inspire – April 2022 Alyssa Stead

Through the Clinicians Who Inspire series, we continue to share motivation, creativity, and inspiration from clinicians in the field. This month, we spoke with Alyssa Stead, COTA/DOR and Champion Level II therapist from Avalon Care Center Sonora. Alyssa shared that though there have been challenges over the past two years, a shifted mindset has allowed the therapy team and residents something to look forward to.

As residents within the dementia unit were isolated from typical routines and interactions during the pandemic per federal guidance, Alyssa and her team took the initiative to create opportunities for meaningful participation. They obtained information about their residents’ interests and created kits that included materials for activities according to those interests. Through participation in these activity kits, Alyssa saw not only satisfaction from the residents, but also a decrease in some of the potential challenging behaviors that presented on their dementia unit. This successful intervention was something that both the residents and therapists could be excited about.

Even as the residents begin to regain a sense of normalcy, these activity kits remain relevant and beneficial. Alyssa Stead, COTA/DOR shared a quote that has always stuck with her, “People don’t care how much you know, until they know how much you care.” Taking the time to learn what is meaningful and motivating to a resident can go a long way in showing that you care.

Thank you, Alyssa and team at Avalon Care Center Sonora, for shifting your mindset and exemplifying Care Matters!

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.

Care Matters Spotlight – Forest Haven Nursing and Rehabilitation

Mr. Freberthauser, a long-term care resident living with dementia at Forest Haven Nursing and Rehab, had been experiencing frequent falls within the facility for a while. With some guidance from Reliant’s Clinical Team, the amazing therapists at Forest Haven worked together to investigate and understand what would work best to engage Mr. Freberthauser and ultimately prevent or reduce falls from occurring. For Mr. Freberthauser, music was the key to improving participation in therapy. The team did some research and found the biggest hits of his generation. When the SLP tried the timeline with country music hits, they really scored. He was beaming with a face full of expression and articulated, “I like to hear Hank Williams music.” The team also found that he performed better with regularly scheduled visits and interactions. Colby Millen, DOR, reports that Mr. Freberthauser “went from stumbling around aimlessly with no affect to smiling when he would see us (the therapy team) and had nicknames for each member of the team.”

With Mr. Freterthauser’s improved attention skills, the therapy team was able to work on the goals they had established. After weeks of therapy, he is now ambulating throughout the facility independently with an improved stable gait and improved safety. He can get out and safely enjoy the activities he loves with as much independence possible. Although there will always be some risk, he has now been fall free for the last month!

In order to set him up for a successful discharge, the therapy team requested that the activities department see Mr. Freberthauser daily to continue to have one-on-one time engaging him in meaningful conversations and allow him a chance to enjoy his favorite music that has improved his quality of life so much.

Thank you to Colby and the Forest Haven therapy team for taking the extra steps necessary to facilitate Mr. Freberthauser’s success!

Discipline Snapshot:

PT: The PT team incorporated music to engage Mr. Freberthauser in meaningful interactions while also working on goals for improved strength, balance, transfer, and ambulation safety.

OT: The OT team also incorporated music and engaging conversation to encourage him in activities to improve his abilities to feed and dress himself.

ST: For ST, facilitating improved engagement has been paramount to the success he has seen. Goals included following directions, comprehension of simple messages, and expression of wants and needs.