Study shows disconnect between CMS infection control surveys and COVID outbreaks

A recent study of data from the Centers for Medicare & Medicaid Services (CMS) by the Center for Medicare Advocacy (CMA) has shown a disconnect between the results of CMS infection control surveys and outbreaks of COVID-19 within skilled nursing facilities.

Infection control citations

In mid-March, CMS announced that inspections would focus on infection control programs – in addition to cases of immediate resident danger – to help suppress the spread of COVID-19 within SNFs. A review of CMS inspection data by CMA showed that a very small portion of infection control surveys resulted in citations. Out of 5,724 infection control surveys performed from the March announcement through June 24, only 99 resulted in citations.1

Of the citations, 93 were marked as having minimal harm or potential for minimal harm, and three were marked as having a potential for minimal harm. The remaining three were marked as putting residents’ health and safety in immediate jeopardy. Thirty-five of the citations resulted in fines.

The disconnect between citations and infections

The concern raised by CMA has been raised by officials in many states, as well as by families of afflicted nursing home residents: With the high rate of COVID-19 cases in nursing homes, the low amount of citations – which translates to 2.4 percent of surveys – seems “implausible,” according to CMA officials. Through the end of June, more than 40 percent of COVID-19 deaths in the United States were related to skilled nursing facilities.2

The CMA’s review showed that several of the CMS infection control surveys that did not result in citations took place even as SNFs were in the middle of COVID-19 outbreaks. Three days after a passing survey at one California facility, there were 68 diagnosed COVID-19 cases documented. The staff refused to return to work over concerns for their safety, and members of the California National Guard were deployed to care for residents.3

Those eyeing the survey results give different causes for the disconnect between passing surveys and COVID-19 infections. Some say SNFs lacked access to the personal protective equipment needed to keep staff and residents safe. Others called out a lack of regular testing among residents and staff. One CMS administrator said the disparity between survey results and infection rates likely shows that SNF staff demonstrated compliance during surveys but failed to follow protocols when they were not under scrutiny.

Maintaining infection control programs

Amidst the COVID-19 pandemic, maintaining infection control protocol has become more important than ever in keeping residents and staff safe. The number of SNF deaths due to the pandemic and the results of the CMA’s data review could lead to further scrutiny of infection control programs or more stringent infection control program requirements.

SNFs can stay on top of regulations, infection control protocol and patient data with ABILITY INFECTIONWATCH. The application allows for easy tracking of McGeer criteria, infection reports and infection control measures. SNFs can tighten their vigilance against infections by customizing infection thresholds; when those thresholds are reached, an alert appears on the ABILITY INFECTIONWATCH dashboard so staff won’t miss the signs of an outbreak.

 

Sources:

1. “Special Report Additional Infection Control Surveys at Nursing Facilities Show Same Results: Few Deficiencies, Most Called ‘No Harm’; Poor Ratings on Nursing Home Compare,” Miriam Edelman, July 9, 2020, https://medicareadvocacy.org/wp-content/uploads/2020/07/Report-Coronavirus-Infection-Controls-Second-Batch-.pdf?emci=0f6236c7-f5c1-ea11-9b05-00155d03bda0&emdi=526f3f5a-0dc2-ea11-9b05-00155d03bda0&ceid=7801066.

2 “More than 40 Percent of U.S. Coronavirus Deaths are to Nursing Homes,” The New York Times, July 23, 2020, https://www.nytimes.com/interactive/2020/us/coronavirus-nursing-homes.html.

3 “As Coronavirus Raged Through Nursing Homes, Inspectors Found Nothing Wrong,” Jack Dolan & Brittny Mejia, June 28, 2020, https://www.latimes.com/california/story/2020-06-28/coronavirus-nursing-homes-state-inspector-covid-19.

 

ABILITY and design® and ABILITY® and ABILITY INFECTIONWATCH® are trademarks of ABILITY Network, Inc.

CMS issues millions in infection control penalties to SNFs

The Centers for Medicare & Medicaid Services (CMS) has imposed more than $15 million in penalties on 3,400 skilled nursing facilities for failure to comply with infection control regulations in the midst of the COVID-19 pandemic. The announcement of the penalties comes with a warning to SNFs to stay vigilant in monitoring their infection control programs.

“Now more than ever, nursing homes must be vigilant in adhering to federal guidelines related to infection control to prevent the spread of infection disease, including COVID-19,” said CMS Administrator Seema Verma. “We will continue to hold nursing homes accountable and work with state and local leaders to protect the vulnerable population residing in America’s nursing homes.”1

Avoid CMS penalties

ABILITY INFECTIONWATCH can help your facility avoid costly CMS penalties with better infection control monitoring. This valuable application makes it easier for your facility to meet all CMS Requirements of Participation, and it allows you to quickly pull reports to meet the requests of surveyors. Using built-in national infection criteria, infection control administrators align facility data with reporting requirements consistently and efficiently.

Accurately track symptoms and infections

As COVID-19 continues to spread throughout the U.S., ABILITY INFECTIONWATCH helps you to protect against outbreaks utilizing your facility’s data. Monitor symptoms, track and report infections, oversee facility visitors and identify the sources of infections through the application. The convenient dashboard allows you to customize alerts so you are notified when your preset data points are reached.

Protect your facility

COVID-19 poses a real danger to SNF residents and staff. And never before have facilities been placed under such scrutiny. ABILITY INFECTIONWATCH provides the tools you need to protect your facility from a coronavirus outbreak. It also allows you to track, access and report the data required by CMS to reduce the risk of survey deficiencies and costly penalties.

Protect your facility from a potential outbreak – and potential financial penalties. Learn more about ABILITY INFECTIONWATCH now.

 

1. “Trump Administration Has Issued More Than $15 Million in Fines to Nursing Homes During COVID-19 Pandemic,” Centers for Medicare & Medicaid Services, August 14, 2020, https://www.cms.gov/newsroom/press-releases/trump-administration-has-issued-more-15-million-fines-nursing-homes-during-covid-19-pandemic

 

ABILITY and design®, ABILITY® and ABILITY INFECTIONWATCH® are trademarks of ABILITY Network, Inc.

The PBJ reporting waiver has ended: what you need to know

In a memorandum released on June 25, CMS announced the end of the COVID-19 emergency waiver for staffing data submissions.

Back in March, CMS had granted a series of blanket waivers to lessen administrative burden and allow nursing homes to focus on responding to the COVID-19 threat. Facilities now must resume submission of their staffing data through the payroll-based journal (PBJ) system as required by regulation.

Why it matters

A recent study published in the Journal of the American Geriatrics Society found that facilities with lower nurse staffing levels and lower scores on the Five-Star Quality Rating System before the pandemic had higher rates of COVID-19 infections and deaths. In fact, higher nurse staffing ratios were strongly correlated with fewer cases and deaths.

The authors of the study recommended that nursing home inspections should target facilities with lower RN staffing levels and quality ratings in addition to those located in areas with high infection rates.

On the heels of these findings, CMS made the announcement that nursing homes must recommence submission of their staffing data, stating that “we continue to emphasize the importance of staffing based on its relationship to quality.”

What this means for your facility

Here’s what you need to know about PBJ data submissions for 2020:

  • Staffing data for April-June is due by the usual deadline of August 14
  • You are not required to submit your staffing data for January-March
  • Nursing Home Compare is displaying the staffing star rating based on your October-December 2019 data
  • New Five-Star staffing ratings, based on your April-June data, will post at the end of October 2020
  • Facilities that received an automatic staffing downgrade to one star for the fourth quarter of 2019 will have their measures and rating temporarily suppressed and that one-star staffing rating downgrade removed

How ABILITY can help

While CMS is giving long-term care providers the opportunity to correct and improve their star rating, the agency plans to restart inspections “as soon as possible.” To protect your star ratings and ensure compliance with the PBJ reporting requirements, it is crucial to act soon. This is where ABILITY can help.

ABILITY CAREWATCH PBJ puts the right tools at your fingertips so you can efficiently collect, classify, validate and submit your facility’s direct care staffing data accurately and on-time.

To see firsthand how easy PBJ reporting can be, request a demo today.

 

ABILITY and design®, ABILITY® and CAREWATCH® are trademarks of ABILITY Network, Inc.

Three tips for better nurse engagement that drives quality care

Nurses are the heart of every healthcare organization. Not only are they passionate about providing expert care, they are also educators, counselors and their patients’ strongest advocates.

While caring for nursing home residents can be rewarding, it is also quite challenging. Working long demanding shifts in a high-stress environment can lead to burnout and high turnover, which can quickly result in sub-optimal care and increased medical errors. In fact, a research report from the University of California San Francisco found that the median turnover rate for nurses at long-term care facilities is 44%, which is significantly higher than the average for the healthcare industry.

Nursing engagement is key to preventing complications and reducing medical errors and mortality rates, according to research by Gallup. Engaged nurses are more responsive to their residents’ needs, more efficient and effective when providing care and less likely to experience burnout or leave their place of employment.

So how can your skilled nursing facility improve nursing engagement? Here are three tips:

1. Encourage and value nursing input

Include and involve nurses throughout improvement initiatives and allow them to be active participants in decision making that impacts the organization, patient care and their nursing role. Nurses will be more engaged if they know their input matters.

2. Ensure accessibility and responsiveness

Nurses need to know they have a committed leadership team behind them. Take steps to make leaders accessible to nurses and responsive to their needs. This builds a trusting relationship, which will drive greater levels of engagement and commitment to your organization.

3. Recognize nursing contributions

Honest and meaningful recognition of a job well done increases loyalty and engagement. Find ways to recognize the many contributions nurses make to their residents and your facility.

Whether done in a public forum or through personal, one-on-one communication, showing appreciation improves nursing morale and instills a sense of pride.

Want to learn more? Discover how ABILITY CAREWATCH can keep your nursing team on the right track with quality initiatives.

 

ABILITY and design®, ABILITY® and CAREWATCH® are trademarks of ABILITY Network, Inc.

Skilled nursing facilities to receive break on reporting staffing data

The Centers for Medicare & Medicaid Services (CMS) has extended timeline requirements for reporting direct staffing data in skilled nursing facilities. The extension is part of a series of blanket waivers to CMS requirements that is designed to relieve bureaucratic stress on SNF staff as they implement infection control programs to combat the COVID-19 outbreak and protect residents.

Under CMS regulations, skilled nursing facilities are normally required to report information on direct staff – anyone responsible for the hands-on care of residents – to the CMS in a uniform format at least quarterly. The waiver applies to data pulled and submitted electronically to CMS through the Payroll-Based Journal (PBJ) system.

The reporting requirements whose timelines are being waived include:

  • The work category for each direct-care staff member
  • Resident census data
  • Staff tenure and turnover
  • The number of care hours performed by each staff member per day
  • Designation of direct-care staff as facility employee, agency worker or independent contractor

Skilled nursing facilities that are overwhelmed by their response to COVID-19 infection or prevention do not have to submit paperwork to take advantaged of the relaxed timeline for reporting direct staffing data. Because the timeline extension was part of a blanket waiver by the agency, it automatically goes into effect for all skilled nursing facilities. The measure, which was announced on April 24, is good for 60 days. That timeframe could be extended based on the ongoing impact of the COVID-19 pandemic.

The extended deadlines for reporting staffing numbers do not apply to data that was due to CMS for its April reports. That data should have been collected before a public health emergency was declared on Jan. 31.

The timeline extension was part of a large series of blanket waivers issued by CMS to help skilled nursing facilities better address and cope with the COVID-19 crisis.

 

Source:

Director, CMS Quality Safety & Oversight Group, April 24, 2020,  memorandum to State Survey Agency Directors. https://www.cms.gov/files/document/qso-20-28-nh.pdf

 

ABILITY and design® and ABILITY® are trademarks of ABILITY Network, Inc.

CMS temporarily lifts MDS reporting timeline

Skilled nursing facilities will see the timeline requirements for reporting the Minimum Data Set (MDS) to the Centers for Medicare & Medicaid Services (CMS) extended as they work to keep residents safe during the COVID-19 pandemic. CMS announced at the end of April that it would provide a blanket waiver for MDS reporting timeline so facilities could focus their energy on infection control programs that could help slow the spread of COVID-19.

The timeline waiver applies specifically to regulations listed under 42 CFR 483.20. The MDS data under that code documents and monitors residents’ conditions by assessing cognitive patters, vision, communication, mood and behavior, psychological and social health, physical function, continence, diagnoses and condition, medication, treatments and procedures, activity and discharge planning.

Some of screenings affected by the timeline waiver include:

  • Pre-admission Level 1 and Level 2 screenings, which are typically required within the first 14 days of admittance
  • Quarterly review assessments, which are required at least once every three months
  • Annual assessments, which are required at least once every 12 months
  • Assessments that mark significant changes in a patient’s condition within 14 days of those changes

Under normal circumstances, all MDS data collected during resident assessments must be encoded within seven days and reported to CMS within 14 days.

Because the waivers were a blanket order issued by CMS, skilled nursing facilities do not have to file any additional paperwork if they will be delaying the reporting of the eligible MDS. The waiver does not apply to MDS required for CMS’s April 29 reports, as that data would have been collected before a public health emergency was declared on Jan. 31. The blanket waiver is in effect for 60 days, though there is a potential to extend the waiver.

 

Source:

Director, CMS Quality Safety & Oversight Group, April 24, 2020,  memorandum to State Survey Agency Directors. https://www.cms.gov/files/document/qso-20-28-nh.pdf

 

ABILITY and design® and ABILITY® are trademarks of ABILITY Network, Inc.

CMS waives hospitalization requirement for SNF patients

The Centers for Medicare & Medicaid Services (CMS) has announced it will waive several requirements for SNF residents impacted by COVID-19. The measures, which were announced at the end of April, are intended to help facilities adapt quickly to accommodate residents – and to help ensure residents are eligible for needed benefits – in light of the COVID-19 pandemic.

Some of the waivers related to SNF patients include:

Hospitalization requirements

With the blanket waiver, patients will be eligible for CMS coverage without the usual prerequisite of three days of prior hospitalization if they have been displaced or been affected by COVID-19.

Renewal of benefits

The provision also allows residents who have exhausted their long-term care benefits to renew their SNF benefits without having to begin a new benefit period if they were prevented from completing and renewing their previous benefits due to the coronavirus crisis. To be eligible, their benefits must have been renewable under normal circumstances.

Pre-admission screening and annual reviews

With the waivers, SNFs will be able to admit patients who have not yet had their Level 1 or Level 2 admissions screenings. Instead, facilities will have up to 30 days after admitting patients to perform the required screenings.

Resident transfers

To allow facilities to create cohorts to care for residents who have been diagnosed with COVID-19, CMS is waiving several transfer requirements, as long as a facility has agreed to receive a resident from another facility. Cohort agreements can allow for the transfer of residents with COVID-19 to allow stricken residents to be isolated in one facility, or residents who test negative for the illness can be transferred to other facilities to protect them from a COVID-19 outbreak within their current facility.

Blanket waivers automatically go into effect, so facilities do not need to submit applications when they take advantage of the waived requirements.

With these waivers, facilities must continue to track infections and infection control measures. Find out how ABILITY INFECTIONWATCH can help your staff track all of the necessary data.

 

Source:

Director, CMS Quality Safety & Oversight Group, April 24, 2020,  memorandum to State Survey Agency Directors. https://www.cms.gov/files/document/qso-20-28-nh.pdf

 

ABILITY and design®, ABILITY® and ABILITY INFECTIONWATCH® are trademarks of ABILITY Network, Inc.

CMS places SNF inspection scores on temporary hold

To help protect skilled nursing facilities against COVID-19 outbreaks, the Centers for Medicare & Medicaid Services (CMS) began focusing inspections on infection control programs in March. With that change, many facilities are not being examined according to the usual schedule, potentially skewing the public quality rating system to negatively impact the ratings of facilities that are being inspected.1 To maintain the integrity of the system, CMS announced April 24 that it would place a temporary hold on the domain of the Nursing Home Five-Star Quality Rating System.

Through the duration of the hold:
• All SNF star ratings will remain consistent for the duration of the hold
• Results of inspections performed after March 4 will appear through a special link on the CMS Nursing Home Compare page
• CMS inspections will continue to focus on infection control programs and immediate threats to patient safety, based on complaints.

The hold will affect all inspections performed after March 4. Results of inspections performed after that date were posted to the public on April 29. Inspection results will continue to be posted as the data is able to be finalized and uploaded to the site. CMS did not reveal an end date for the hold of the rating system.

The announcement regarding the Five-Star Quality Rating System came along with other announcements about CMS requirements for skilled nursing facilities, including staffing data and the Minimum Data Set.

While ratings for skilled nursing facilities will remain unchanged for the foreseeable future, it is important for nursing facilities to diligently maintain their infection control programs to protect residents and staff, and to be prepared if an inspection does occur. ABILITY INFECTIONWATCH can help your facility track the data it needs to monitor its infection control program. Find out how.

 

Source:

1. Director, CMS Quality Safety & Oversight Group, April 24, 2020, memorandum to State Survey Agency Directors. https://www.cms.gov/files/document/qso-20-28-nh.pdf

 

ABILITY and design®, ABILITY® and ABILITY INFECTIONWATCH® are trademarks of ABILITY Network, Inc.

Four best practices for nurturing a collaborative nursing culture

True collaboration – where joint communication and decision making occur among all the members of a healthcare team – is a cornerstone of quality care. Studies have shown healthcare teams who do not trust, respect and collaborate with one another are more likely to make a mistake that could negatively impact the safety of patients.

Fortunately, you can apply four best practices to nurture a collaborative nursing culture.

1. Foster open communication

Regular and routine communication and information sharing is essential to building transparency, collaboration and resident-centered care. Adopt methods and tools that enable frequent, clear communication, such as a handoff template, briefs, huddles, debriefs and mobile alerts.

2. Create a safe space for information sharing

Nursing teams deserve an environment that is respectful, nonpunitive and reinforces the value of each member’s input. Develop communication guidelines that promote an open exchange of information through listening and constructive responses while discouraging any ridicule of questions or opinions.

3. Encourage shared responsibility

Nurses need to understand their individual roles and responsibilities within the team. Clearly outline who will have leadership roles and how decision making will be shared across the team, so they can collaboratively achieve the team’s goals.

4. Promote constructive conflict resolution

Different perspectives, backgrounds and areas of expertise can inevitably lead to differences of opinion and conflict within a nursing team. Failure to properly address conflicts often leads to more issues and negatively affects team morale. Establish a conflict resolution process that educates team members on how to acknowledge, manage and resolve any conflict in a positive and constructive manner.

There’s no doubt that a collaborative nursing culture leads to more efficient and effective resident care. In skilled nursing facilities, breakdowns in communication can lead to medication errors, resident injuries and other poor outcomes. When healthcare teams commit to the common goal of elevating resident care by bringing together each member’s unique knowledge and skills, everyone wins.

Coming soon! In our next installment of this series, you’ll discover three tips for improving nurse engagement in your skilled nursing facility.

See how SNFs across the U.S. help their clinical teams collaborate to elevate resident care with ABILITY CAREWATCH.

 

ABILITY and design®, ABILITY® and CAREWATCH® are trademarks of ABILITY Network, Inc.

Empower your nurses to focus on resident-centered care

Nurses are the frontline of resident care – they spend more time at the bedsides of those in their care than most other healthcare team members. No one knows better than a skilled nursing professional that the best way to achieve better outcomes is to maximize direct contact with each resident. With a focus on individual needs and preferences, nurses can improve quality of care and life for their residents.

Staff nurses aspire to provide the best care possible to their residents, but are often frustrated by a lack of time, resources and autonomy.

Here are three ways your healthcare facility can help your nursing team to be more productive and elevate resident care.

1. Ensure adequate staffing

Making sure that your facility is staffed appropriately is a crucial element to providing high-quality care. Not only does inadequate staffing adversely affect your star ratings, it can overwhelm your nursing staff and result in unsafe care. With optimum staffing levels, your nurses are empowered to provide excellent resident care.

2. Equip nurses with the right tools

Frontline nurses need easy-to-use and readily accessible tools and resources to boost their autonomy and confidence in delivering evidence-based care. Make sure they have:

• Standardized checklists for assessments
• Actionable data to prioritize care
• Access to resources that expand their knowledge base
• User-friendly technology that promotes regulatory compliance

3. Simplify workflows

In today’s healthcare environment, it’s all too common for nurses to feel pressure to increase productivity and report a high administrative workload. Creating more efficient workflows is a frequently overlooked way to give nurses more time to focus on resident care.

Examine current workflows and look for “time-eaters.” One of the easiest ways to improve nursing efficiency is to reduce manual processes. Look for user-friendly technologies and applications that help nurses streamline their workflows and make more efficient use of their time.

Don’t miss the next blog article in this series to learn best practices for nurturing collaborative nursing!

Have you heard how skilled nursing facilities are simplifying quality management? Check out ABILITY CAREWATCH, the easy-to-use application that’s truly elevating resident care.

 

ABILITY and design®, ABILITY® and CAREWATCH® are trademarks of ABILITY Network, Inc.