When we talk about providing excellent care, it’s important to understand the deeper layers of what that truly means. Abraham Maslow developed a theory that represents the progression of human needs starting with basic physiological requirements all the way up to self-actualization. Essentially, it’s telling us that before individuals can focus on pursuing personal growth and fulfillment, their fundamental needs must be met.

 

 

As a health care provider, whether you are a clinician or in admissions, Maslow’s Hierarchy of Needs plays a large role. How our patients, partners, and stakeholders place value and perceive the delivery of care and experiences they have with us, their doctor, hair stylist, grocery store, etc. You get the picture. The lenses of our world are colored individually and driven by what we need for fulfillment consciously or subconsciously.

 

Wait…doesn’t the ‘care’ come first?

You’re absolutely right — care should always come first! But let’s face it, “care” can be highly subjective and can mean different things to different people. It’s a bit like love languages. For example, I tell my husband all I need is food, water, and compliments, while he expresses his love through acts of service.

When a new patient is admitted, the first 72 hours are crucial. This is the window in which they form their initial impressions and start to gauge the quality of care they will receive. The timing of their admission might not be ideal (such as 4:40 pm on a Friday), but that’s when they rely on you the most to ensure their transition is smooth and their environment feels safe and welcoming. As they navigate their new environment, they’re not just looking for medical care; they’re also seeking emotional reassurance and a sense of belonging.

They might not fully grasp the intricacies of what it takes to make their care effective, but they know if you are attentive, kind, and hospitable — because then you are checking all of the boxes in their “love, belonging, and esteem category”. Making time to be genuinely welcoming and considerate is not just a courtesy; it’s a fundamental part of providing high-quality care. It’s more about just being “nice”. Making our patients and families feel involved, informed, and goal-oriented is essential to coming full circle in the “CX” or Customer Experience. This ensures that patients feel seen, heard, and valued from the very start of their journey with us.

The Facility Assessment required as of August 8, 2024 was at § 483.70(e) is now moved to § 483.71.

Question: Do therapists and assistants have anything to do with the facility assessment?

Answer: Yes, therapists and assistants count as services provided which are required to be part of the facility assessment. Contracted services also count towards the requirement.

Please also note the definition of direct care staff for the Minimum Staffing Rule is different than the one used for PBJ purposes.

 

Section from the CFR:

 

Additional details to enhance our understanding of the requirements:

• Requires each LTC facility to conduct and document a facility-wide assessment to determine what resources are necessary to care for its resident population competently during both day-to-day operations and emergencies.
• The assessment must address or include an evaluation of the resident population, the facility’s resources, and a facility-based and community-based risk assessment that utilizes the all-hazards approach.
• Requires an Annual Update

 

Goals:

• Advanced equitable, safe, and quality care sufficient to meet the nursing needs of all residents and greater consistency across facilities.
• Facility assessment allows the staff to provide meaningful input regarding the facility’s operations, which has the potential to lead to a better working environment that complements retention and hiring efforts.
• Facilities are tasked with developing their facility assessments to determine the personnel needed to meet residents’ needs.

 

Definitions of Direct Care Workers and Support Staff

At § 442.43(a)(2), for the purposes of the proposed reporting provision at § 442.43(b), we proposed to define direct care workers to include: nurses (registered nurses, licensed practical nurses, nurse practitioners, or clinical nurse specialists) who provide nursing services to Medicaid-eligible individuals receiving nursing facility and ICF/IID services; certified nurse aides who provide such services under the supervision of one of the foregoing nurse provider types; licensed physical therapists, occupational therapists, speech-language pathologists, and respiratory therapists; certified physical therapy assistants, occupational therapy assistants, speech-language therapy assistants, and respiratory therapy assistants or technicians; social workers; personal care aides; medication assistants, aides, and technicians; feeding assistants; activities staff; and other individuals who are paid to provide clinical services, behavioral supports, active treatment (as defined at § 483.440), or address activities of daily living (such as those described in § 483.24(b), which includes activities related to mobility, personal hygiene, eating, elimination, and communication), for individuals receiving Medicaid-covered nursing facility and ICF/IID services.

 

Our proposed definition of direct care worker differs from the definition of direct care staff in LTC facilities at § 483.70(q)(1), which was established for the PBJ reporting program at § 483.70(q).

Imagine the interdisciplinary team at a SNF preparing to capture a snapshot of a patient’s readiness to “leave the nest” of the healthcare facility to return to their home. It’s a multifaceted process, assessing everything from how smoothly they move to how adeptly they tackle daily tasks.

 

Out with the Old. In with the New.

Currently, healthcare providers and therapists, armed with tools like the Functional Independence Measure or the Barthel Index meticulously assess every aspect of a patient’s functional prowess. Can they stride down the hallway? Can they complete daily tasks such as eating and oral hygiene without breaking a sweat? These scores paint a vivid portrait of their independence and self-sufficiency.

October 2024: CMS will replace the Percentage of Residents Who Made Improvements in Function (Short Stay) measure with the new Discharge Function Score measure which was finalized in the FY2024 SNF PPS Final Rule for use in the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) and the SNF Value-Based Purchasing (VBP) program. The remaining four measures will remain frozen until January 2025 while the data for the equivalent measures are collected.

The new Discharge Function Score Measure determines how successful each SNF is at
achieving an expected level of functional ability for its patients at discharge.

 

Why Should You Care About The Discharge Function Score?

These scores aren’t just numbers in a chart; they’re the cornerstone of how CMS will determine if the patient function is progressing in a manner that is expected and will be used in the SNF Quality Reporting Program. The final Discharge Function Score for a given SNF is the proportion of that SNF’s stays where a resident’s observed discharge score meets or exceeds their expected discharge score. According to CMS, SNFs with low scores are “not producing the functional gains they could be for a larger share of their patients.”

And let’s face it, this measure’s first year in the program is 2027 which is fast approaching. The first performance period begins FY 2025 (October 1, 2025) and everyone needs to be prepared.

 

The Roles of Each Stakeholder

We have been preparing each therapist through the ongoing education of Section GG. HTS Therapists continually receive additional education, auditing, and coaching to ensure accuracy. Therapy will be coding Section GG as is the norm. However, this is a great time and opportunity to modify your systems so that a collaborative approach from all stakeholders is well-defined when coding Section GG on the MDS. Also, it is of utmost importance that facilities ensure information is being coded to the best of their ability. Otherwise, statistical imputation occurs and it could skew data to seem like the facility isn’t doing as well as it could have been if the information had been input as intended.

Therefore, when you hear about a discharge function score, remember—it’s definitely not just a number. It is the key to showing a SNF’s collaborative, interdisciplinary approach to rehabilitating a patient to their prior level of function as expected.

For additional information, view the CMS Discharge Function Score for SNFs Technical Reports: snf-discharge-function-score-technical-report-february-2023.pdf (cms.gov)

 

HTS Partners, feel free to contact me or your Regional Director for more information. As your partner in therapy, we will continue to keep you apprised of this topic along with many others.

Written by: Sheena Mattingly, M.S., CCC-SLP, RAC-CT

One simple yet powerful way to support our health is by spending a little time in the sun. Exposure to sunlight offers a host of benefits, from enhancing your mood to strengthening your bones.

Key Health Advantages of Soaking up Some Sunshine:

• Enhance Your Mood: Sunlight increases serotonin levels, a hormone that boosts mood and promotes a sense of well-being.
• Better Sleep Quality: A daily dose of sunlight can help regulate our circadian rhythm, signaling to our body when to be awake and when to sleep.
• Boost Vitamin D Levels: Sunlight helps our bodies naturally produce Vitamin D which also helps maintain healthy bones and a strong immune system.
• Heart Health: Sunlight can help lower blood pressure by stimulating the production of nitric oxide in the blood vessels, improving blood flow, and reducing risk of hypertension.

Tips to enjoy the sunshine safely:

• Aim for 5 to 15 minutes of sunlight exposure a few days per week
• Apply broad-spectrum sunscreen with at least SPF 30
• Wear protective clothing, a hat, and sunglasses
• Stay hydrated, especially on hot and sunny days

How Can Therapy Help?
Therapy can help you safely enjoy the benefits of spending time outdoors. Physical therapy focuses on improving mobility, strength, and balance, making it easier and safer to get around. Occupational therapy offers strategies and tools to handle outdoor challenges, such as walking on uneven terrain or gardening activities. Additionally, occupational therapists may recommend assistive devices like canes, walkers, or specialized equipment to make outdoor activities more accessible.

Swallowing is a complex process that involves over twenty-five muscles all working together to move food from the mouth to the stomach. For many older adults, swallowing can become a challenge.

Swallowing disorders, also known as dysphagia, can greatly impact our ability to enjoy meals and stay properly hydrated. If you find eating or drinking feels hard, experience symptoms such as coughing, choking, or feeling of food being stuck – you might be dealing with dysphagia.

Here are some common signs that may indicate you have a swallowing problem:
• Frequent coughing or choking while eating or drinking
• A feeling of food or liquid getting stuck in your throat or chest
• Pain or discomfort in your throat or chest when swallowing
• Unintentional weight loss or dehydration
• Recurrent respiratory infections or chest congestion

 

How Can Speech Therapy Help?

Speech-Language Pathologists (SLP) are uniquely qualified to help people who are experiencing problems with eating and drinking. During treatment, a SLP may recommend swallowing exercises along with other strategies to help manage dysphagia. If you or a loved one experience difficulty swallowing, talk to your doctor about Speech Therapy. Early identification and treatment of swallowing problems can help prevent complications and improve your quality of life.