HCPro.com - Contemporary Long-Term Care Weekly

Quick poll: Which aspect of ambulance billing does your facility struggle with more?

Thu, 19 Nov 2009 20:41:00 GMT

To respond to this week's question, scroll to the bottom of the long-term care page on HCPro's Web site.

Tip of the week: Recognizing bacteria in long-term care facilities

Thu, 19 Nov 2009 20:37:00 GMT

Illnesses are common in healthcare settings. Long-term care facilities are no different. The following list offers details about bacteria that are often found in facilities:

Bacillus cereus: Found in soil, dust, and food products, this bacterium can cause diarrhea and vomiting.
Campylobacter jejuni: This is possibly the most common infective agent for food borne illnesses. It is frequently found in raw poultry. Therefore, it is important for poultry to be thoroughly cooked. Furthermore, avoiding cross-contamination is critical in limiting the spread of this bacterium.
Listeria monocytogenes: Common in soil, waste, plants, and food (specifically inadequately pasteurized milk), this bacterium causes listeriosis, which can be fatal.
Vibrios: There are several species of Vibrios, which are small, curved bacteria. The most well known is Vibrio cholerae, which causes cholera. Others can cause gastroenteritis and septicemia.
Streptococcus pneumoniae: Also called pneumonococcus, this is a diplococcus bacterium that causes some forms of pneumonia. It can also cause other infections, such as endocarditis, cellulitis, and meningitis.
Haemophilus influenzae: There are many forms of Haemophilus influenzae, with most forms being opportunistic, meaning the person can harbor these pathogens without having any disease. Often, disease occurs where there is an opportunity for infection and immunity is reduced. It can cause pneumonia, meningitis, conjunctivitis, and osteomyelitis, among other diseases.

This is an excerpt from HCPro’s book, The Long-Term Care Administrator’s Field Guide, by Brian Garavaglia, PhD.

H1N1 hits Maine facility

Thu, 19 Nov 2009 20:34:00 GMT

The H1N1 influenza virus has found its way into a long-term care facility in Kennebec County Maine this week, according to the Kennebec Journal Morning Sentinel. State health officials did not release the name of the facility, which is closed to visitors at this time.

The facility is the first in Maine to face an H1N1 outbreak. The severity of the virus’ presence is not known, but residents and staff members have been given antiviral medications. The news of the infected long-term care facility accompanied the death of two Mainers due to H1N1.

Senate bill to include long-term care insurance program

Thu, 19 Nov 2009 20:18:00 GMT

The Senate health bill, which was drafted using the two bills that previously passed through Senate committees, is expected to contain a new long-term care insurance program, according to The Wall Street Journal.

The provision initially appeared in late Senator Edward Kennedy’s Community Living Assistance Services and Supports (CLASS) Act. The House health bill includes a similar provision. Under the proposed program, which would make long-term care insurance available to all employees, individuals would be free to decline participation. Premiums would be deducted from the paychecks of those who chose to take advantage of the program.

Tip of the week: Recognizing bacteria in long-term care facilities

Thu, 12 Nov 2009 16:04:00 GMT

Illnesses are common in healthcare settings. Long-term care facilities are no different. The following list offers details about bacteria that are often found in facilities:

Clostridium difficile: Also called C. diff, this is an anaerobic bacterium, meaning it does not need oxygen for its existence. It is often spread through the fecal-oral route, where poor hand washing and cross-contamination are the agents of infection. C. diff leads to a very odiferous diarrhea. Residents with C. diff should be isolated to prevent spreading.
Clostridium perfringens: Also anaerobic, it is a spore-forming bacterium that can spread harmful toxins in the body. Clostridium perfringens is found in soil, animal and human waste, food, and dust, and can be transmitted from insects as well. It produces flu-like symptoms as well as more serious issues such as gangrene.
Staphylococcus aureus: A coccus bacterium that has potentially life-threatening implications, Staphylococcus aureus has become resistant to many antibiotics. It is commonly found on skin, within the nasal passages, and on the hands.
Escherichia coli: Often referred to as E. coli for short, this is a bacterium found in fecal contaminants. It can be fatal, especially to those who are physically compromised. Many forms of E. coli infection come from food, especially uncooked or undercooked meats.
Salmonella: There are many types, but the two most common are Salmonella typhimurium and Salmonella enteritidis. Those who are infected will often experience severe diarrhea and stomach cramps. Infections can come from food, especially unpasteurized eggs and milk products, or by not cooking these products thoroughly.

This is an excerpt from HCPro’s book, The Long-Term Care Administrator’s Field Guide, by Brian Garavaglia, PhD.

Empathy is key in November, National Alzheimer’s Awareness month

Thu, 12 Nov 2009 15:59:00 GMT

Empathy allows us to understand people suffering from dementia. Sometimes their way of expressing themselves comes across as a challenging behavior. But nursing home staff should see it as a sign of distress and recognize that something is wrong. For example, if a resident becomes violent during a shower, reframe it, and understand they are upset and trying to reach out. Put yourself in their shoes.

Empathy comes from a level of intelligence and acknowledges how we are viewed by that resident and what we’re trying to do. In order to have empathy for someone you need to understand their life story, what’s truly important to them. Then it will be easier to provide daily care. A caregiver needs to know to begin everything with empathy and see beyond behaviors.

For more information on caring for residents with Alzheimer’s disease, visit the Alzheimer’s Resource Center of Connecticut’s Web site.

Nursing home tackles Sunday boredom with fantasy football league

Thu, 12 Nov 2009 15:50:00 GMT

A Massachusetts skilled nursing facility is giving its residents a reason to cheer every Sunday afternoon. The Beaumont Rehabilitation and Skilled Nursing Center in Northbridge, MA started a fantasy football league this year as a way to extend creative programming, according to The Boston Globe.

About a dozen residents gather each week in the facility’s third-floor common room to watch the teams they selected in a preseason draft. The league serves as a social outlet for the residents, who saw their favorite activity – visits with children at Beaumont’s on-site daycare center – suspended due to the seasonal and H1N1 influenza viruses.

Quick poll: Does your facility provide frontline staff with chronic obstructive pulmonary disorder (COPD) training?

Thu, 05 Nov 2009 21:38:00 GMT

To respond to this week's question, scroll to the bottom of the long-term care page on HCPro's Web site.

Tip of the week: Recognizing parasitic agents in long-term care facilities

Thu, 05 Nov 2009 21:33:00 GMT

Illnesses are common in healthcare settings. Long-term care facilities are no different. The following list offers details about parasitic agents, which do not always lead to immediate symptoms and can take some time to present themselves, that are often found in facilities:

Body mites: These are very small parasitic agents. One of the most common body mites is the scabies mite that borrows under the skin and causes extreme itching and irritation. Most individuals who have been involved in long-term care have witnessed scabies outbreaks. Scabies is transmitted from skin to skin, or from bed linen or clothing.
Trichinella spiralis: This parasitic agent, often transmitted through food, can attach to the muscle and brain tissue and wreak havoc in a person. Since the agent of transmission is often food, especially pork, that is not fully cooked, the most important way to prevent infections is to thoroughly prepare food.
Giardia: This is a protozoan agent that is often found in water, fruits, and raw vegetables. In most areas of the U.S., transmission of this agent is not through water. However, fruits and raw vegetables, often a favorite food of many older adults, is a possible transmission source.
Cryptosporidium: Also referred to as crypto, this is a parasite that lives in a person’s intestines. It is a diarrheal disease that is most commonly picked up from water, but it can also be found in food or on contaminated surfaces. It causes watery diarrhea and it can lead to dehydration.

This is an excerpt from HCPro’s book, The Long-Term Care Administrator’s Field Guide, by Brian Garavaglia, PhD.

Study: Action can be taken to reduce dementia risk

Thu, 05 Nov 2009 21:30:00 GMT

New research published on Monday in the Archives of General Psychiatry suggests that the risk of developing certain forms of dementia, including Alzheimer’s disease, can be limited based on changeable lifestyle factors, according to U.S. News & World Report.

Those factors include high blood pressure and high levels of cytokines, an inflammatory protein. The study involved 206 volunteers whose parents had developed dementia. The researchers found that compared with individuals whose parents had not developed dementia late in life, the volunteers were more likely to possess the aforementioned factors. While this evidence supports the idea that dementia-risk is tied to lifestyle choices, the researchers note that it appears 60% of an individual’s risk is related to genes.

Omnicare to pay $98 million to settle kickback charges

Thu, 05 Nov 2009 21:24:00 GMT

The Justice Department announced on Tuesday that Omnicare Inc., which faced charges involving kickback arrangements with several nursing homes and pharmaceutical companies, will pay $98 million to settle outside of court, according to The Wall Street Journal.

One of those pharmaceutical companies, IVAX Pharmaceuticals, a unit of Teva Pharmaceutical Industries Ltd., has agreed to pay $14 million to settle its involvement in a kickback scheme with Omnicare, which disputed the Justice Department’s findings in a written statement. Johnson & Johnson is also alleged to have been involved in the kickbacks. According to the Justice Department, Omnicare’s apparent actions resulted in false Medicare and Medicaid claims.

CMS releases final MDS 3.0 item set

Sun, 01 Nov 2009 19:02:00 GMT

The Centers for Medicare & Medicaid Services (CMS) released the much anticipated final MDS 3.0 item set on October 29, giving long-term care providers approximately one year to prepare for implementation of this new assessment tool.

“The release of the final MDS 3.0 item sets is very exciting news for the long-term care industry,” says Diane Brown, a regulatory specialist, consultant, and Boot Camp instructor at HCPro. “Although the previous drafts gave us a good idea of what to expect, facilities could not do much in terms of preparation without the final version. Now, we can start preparing for the October 2010 implementation, which will be here before we know it.”

In addition to the various item subsets for each MDS 3.0 assessment (e.g. admission, quarterly, annual, etc.), CMS released the following files:

MDS 3.0 Item Matrix – This document identifies the items required for each type of assessment along with how the item is used.
Data Technical Files – This file contains the following MDS 3.0 technical specification information:
- MDS 3.0 Data Submission Specifications – Detailed data submission specifications for MDS 3.0.
- RUG-IV SAS Package – Thoroughly tested SAS code for RUG-IV classification with documentation and test data.
- RUG-III MDS 3.0 Mapping Specifications – This document presents logic that can be used to produce RUG-III classifications using assessment items contained on MDS 3.0.
- MDS 3.0 Care Area Trigger (CAT) Specifications – For each Care Area, this document provides CAT specifications for the MDS 3.0 items used in triggering the Care Area, the conditions for triggering, and Visual Basic code for triggering. The CATs are replacing the MDS 2.0 Resident Assessment Protocols (RAP).

The release of the MDS 3.0 RAI User’s Manual, however, has been delayed. Rather than release the manual in its entirety, CMS is planning to release it in sections and anticipates that Chapters 1, 2, 3, 5, and 6 will be published in November, while Chapter 4 (Care Area Assessments (CAA)) and Appendix C (CAA resources) will be released in December.

According to CMS, the manual, once published, will include “description and instructions for types of assessments and tracking documents, each MDS 3.0 item, the CAA, submission and correction of MDS 3.0 records, SNF and Swing Bed Prospective Payment System (PPS) policy for the MDS 3.0, and the RUG-IV classification system.”

“Once the RAI User’s Manual is released, we will have a better understanding of how to code the MDS 3.0,” Brown says.

To view the final MDS 3.0 item set, visit the Resources page on MDSCentral.

Tip of the week: Recognizing viruses in long-term care facilities

Thu, 29 Oct 2009 18:52:00 GMT

Illnesses are common in healthcare settings. Long-term care facilities are no different. The following list offers details about viruses that are often found in facilities:

Hepatitis A: This form of hepatitis is frequently transferred by food. However, it can also be spread by an infected person passing on body fluids that are infected with this agent or through improper hand washing techniques and passing on fecal contaminants.
Hepatitis B: A very serious form of hepatitis that is often spread by an infected person through his or her body fluids. Healthcare workers should be immunized for hepatitis B so that they have a level of antibody protection.
Hepatitis C: Possibly the most insidious form of hepatitis, hepatitis C ravages the liver and is the number one reason for deaths attributed to liver disease. Currently, there is no immunization to protect against this virus.
Norovirus: In recent years, this virus has become prevalent throughout the United States. In addition, it has been making its way into many long-term care environments. It is highly contagious; therefore, hand washing is extremely important to help control the spread of this virus. Norovirus symptoms include nausea, vomiting, diarrhea, abdominal cramps, fever, and headaches. Dehydration is often a major secondary factor that has to be closely monitored for those who acquire this viral agent.
Varicella virus: The same virus responsible for chickenpox can also lead to shingles or herpes zoster. The virus often remains dormant along major nerve areas and then erupts with painful, fluid-filled blisters. Those who are not immune to chickenpox can get shingles.

This is an excerpt from HCPro’s book, The Long-Term Care Administrator’s Field Guide, by Brian Garavaglia, PhD.

National cost of long-term care increases in 2009

Thu, 29 Oct 2009 18:29:00 GMT

The average cost of a private room at a nursing home is $219 per day, a 3.3% rise from last year, according to the South Florida Business Journal, which cited a survey by the MetLife Mature Markets Institute.

The survey found that Alaska, at $584 per day, was the most expensive state in terms of nursing home private room costs. At $132 per day, Louisiana was found to be the cheapest. In addition to rising nursing home costs, assisted living expenses also increased this year to an average of $3,131. The overall 3.3% rise in long-term care costs parallel the increase in general medical care from a year ago.

Debate rages on over long-term care insurance

Thu, 29 Oct 2009 18:18:00 GMT

Among the many provisions that Congress continues to dispute in working towards healthcare reform legislation is the idea of a government-run long-term care insurance program. Senate and House members form both sides of the aisle are questioning its actual value to the public, as well as its cost in the coming years, according to The Washington Post.

The program was included in late Senator Edward Kennedy’s (D-MA) Community Living Assistance Services and Supports (CLASS) Act. In his plan, long-term care coverage would be available to all Americans, who would be automatically enrolled with the choice to opt out. The government would control premium costs and the extent of cash benefits, which become available to an individual after five years in the program. The ability to immediately begin collecting premiums with a delay in paying benefits made the plan extremely attractive from a budget standpoint, but concern looms over the program’s cost down the road.

Quick poll: How often does your facility receive additional documentation requests (ADRs)?

Thu, 22 Oct 2009 18:24:00 GMT

To respond to this week's question, scroll to the bottom of the long-term care page on HCPro's Web site.

Tip of the week: Understanding basic rules of consolidated billing

Thu, 22 Oct 2009 18:19:00 GMT

Administrators need to understand a few basic rules when dealing with the consolidated billing system. The first is the 35/18 rule. The top 35 RUG categories, which are composed of rehabilitation categories, hold the presumption of meeting the level of care for SNF reimbursement. The lower 18 are not as clear-cut for SNF reimbursement. The 7/5 rule states that residents must receive skilled nursing care seven days each week and rehabilitation services five days each week for Medicare Part A reimbursement under the skilled consolidated billing system. The midnight rule states that the facility is allowed to bill for all Medicare Part A residents who are in bed at midnight. The three-day qualifying stay says that a person who has Medicare Part A must have been admitted to a hospital and spent three consecutive nights there before he or she can receive Medicare Part A nursing home coverage. If there is a three-day qualifying stay at the hospital, there are three situations that the 30-day rule may impact:

The resident goes home, but is admitted to the nursing home within 30 days and is skilled, then he or she can be covered under Medicare
The resident is not skilled upon entry to the nursing home, but becomes skilled within 30 days of entry
The resident is skilled and is cut from Medicare services because he or she is no longer skilled, the facility has 30 days to reinstate Medicare

This is an excerpt from HCPro’s book, The Long-Term Care Administrator’s Field Guide, by Brian Garavaglia, PhD.

Former nursing home aide ascends to Ugandan throne

Thu, 22 Oct 2009 18:15:00 GMT

On October 19, President Yoweri Museveni and the people of Uganda recognized Charles Wesley Mumbere, who worked for nine years as a nursing aide in greater Harrisburg, PA, as the King of Rwenzururu, a mountain kingdom in western Uganda, according to The Patriot News.

Mumbere came to the U.S. in 1984 for an education that was to be paid for by the Ugandan government, which no longer recognized kingdoms and negotiated Mumbere’s arrangement as part of a peace deal with the Bakonjo people. But three years later, the government was overthrown, ending Mumbere’s educational stipend. He took a job as a nurse’s aide in Washington, D.C. before eventually moving to Harrisburg in 1999 and once again finding work in a nursing home. In recent years, the government discussed restoring certain kingdoms for cultural purposes, which led Mumbere to return to Uganda last July and claim his throne.

Illinois task force handles concern over nursing home safety

Thu, 22 Oct 2009 18:09:00 GMT

The Nursing Home Safety Task Force, a group appointed by Illinois Governor Pat Quinn to address the placement of young adults with mental illness into nursing homes, held a four-hour hearing on October 20. The platform served as an opportunity for the task force to let its concerns be known, while allowing members of the public – which included reform advocates, industry personnel, nursing home residents, and social workers – to voice their opinions regarding the issue, according to the Chicago Tribune.

For years, Illinois has used nursing homes to house young, mentally ill felons. State background checks were intended to weed out dangerous potential residents, but episodes of violence persist. As a result, many in the Illinois long-term care industry, as well as the government, are calling for changes that would disallow the placement of mentally ill young adults into nursing homes. Currently, Prairie State nursing homes serve approximately 15,000 individuals whose primary diagnosis is mental illness.

Tip of the week: Things to remember when conducting MDS 3.0 interviews

Thu, 15 Oct 2009 20:05:00 GMT

The MDS 3.0 will implement new guidelines for conducting interviews that will help capture the voice of residents. Although adapting to this new direct interview format may be challenging, interviews under the MDS 3.0 and QIS are expected to help produce better clinical outcomes, customer satisfaction, and survey outcomes. To conduct a successful MDS 3.0 interview, long-term care staff members must:

Choose an appropriate time. Interview a resident or family member at his or her convenience.
Come to the interview with a clear mind and leave any distractions behind.
Take control of the environment. The location should be quiet, private, and free from distractions.
Explain the purpose of the interview.
Use appropriate language and speak slowly. Do not rush the interviewee.
Develop rapport.
Pay attention to body language, which is a good indicator of the interviewee’s current condition.
Practice skilled listening. Make understanding gestures, such as head nods and sounds. Pay attention to the interviewee’s responses and make eye contact.
Validate or clarify information as you go.
Give the resident the opportunity to ask questions and then close the interview.

This is an excerpt from HCPro’s book, Interviewing Essentials for MDS 3.0 and QIS: A Training Handbook for LTC Professionals, by Diane Brown.