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Indiana National Guard Assistance for Nursing Facilities

On October 21, 2020, Governor Holcomb and the Indiana Department of Health (IDH) announced the Indiana National Guard would be utilized for administrative and other similar tasks at nursing facilities in Indiana, in order for nursing facility staff to be able to focus their time on providing resident care.

The Indiana National Guard will be sent to nursing facilities in three phases—on November 2, November 9, and November 16—based on the need / outbreak status of the facility. Those nursing facilities in Phase 1 and Phase 2 will be assigned three guard members each, and those nursing facilities in Phase 3 will be assigned two guard members each.

Click here for all the details.
Click here to download a list of phases and locate your facility in the applicable phase.

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Stories from the Field

Meet HTS SHEro Jessica Duffy

You may be asking yourself, what exactly is a SHEro? A SHEro is a woman admired for her courage, outstanding achievements or noble qualities; a heroine. The pandemic has made it clear that HTS has been blessed with many heros and sheros but for this story from the field’s purposes we will focus on Jessica.

“Great leaders don’t set out to be a leader, they set out to make a difference. It’s never about the role…always about the goal.” Author Unknown

Jessica is an OTR and Regional Director who has been with HTS for 13 years. Like many HTS facilities, staffing became cumbersome due to a COVID-19 outbreak resulting in therapists being unable to provide therapy at multiple buildings. This has become common practice and is done in order to mitigate risk of exposure. Jessica knew there was a need and immediately jumped in to help navigate this all too familiar situation. Census soon began increasing a couple months after the pandemic began. Jessica took swift action to assist with the staffing issue which ensued. She began by facilitating and setting-up PT with telehealth treatment sessions. Jessica herself also served as the primary therapist and OTR for the facility. As she juggled her primary responsibilities to provide support and management for her region, she also provided patient care to ensure each patient received the vital therapy services needed.

“Ultimately, it is our responsibility to the patients we serve to figure out a way to make it work” said Jessica. And make it work she did! According to Jessica and the therapy team, the most challenging aspect of an outbreak within a SNF is logistics. Scheduling of patients becomes tricky at times as does assuring all precautions are appropriately taken to keep the staff and the families they return home to safe. Jessica does have a tip for other facilities going through a similar situation… over-communicate. Educating nursing staff on patient needs observed during therapy (which are constantly changing and evolving) is of utmost importance. Communication of isolation, environmental stimulation techniques, and activity engagement to combat contagion and depression risks are some examples of the training Jessica has provided facility staff members.

Jessica is encouraging fellow therapists to assure they are taking time for themselves and engaging in activities that are fulfilling. Jessica herself likes to spend time with her family outdoors which has helped her refocus during stressful, overwhelming times. Just as many of our star therapists in the field, Jessica has gone above and beyond and for that we thank her (and you)!

 

Past Stories From the Field can be found on the HTS Portal. Have a great “Hoping & Coping Story from the Field ” you would like to share with fellow HTS therapists?

Email Sheena Mattingly, Director of Clinical Outcomes at sheena@htstherapy.com for your chance to be featured in a “Story from the Field!”

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Healthy Habits to Benefit Your Brain and Body

Although research is still developing, there is strong evidence that people leading a healthy lifestyle can lower their risk of developing Alzheimer’s disease and other types of dementia. By following these tips, you can take the steps to reduce your risk of cognitive decline.

1. Cardiovascular Exercise
Incorporate physical activity that raises your heart rate and increases blood flow to your brain and body such as walking, swimming, and aerobics.

2. Brain Challenge
Stimulate your brain by playing bridge, chess, and crossword puzzles. Challenge your brain by trying something new like learning a new language or playing an instrument.

3. Healthy Diet
The Alzheimer’s Association suggests a diet that is rich in vegetables and fruits and low in fat may help to protect brain cells.

4. Laughter
Most people agree that laughing can cheer you up, but did you know laughing can lower stress hormones, stimulate your brain, and reduce stress. Tell a funny story to a friend or watch a comedy movie.

5. Sleep
During sleep, the brain is able to repair and regenerate. Quality sleep is essential for healthy brain function.

If you or someone you know is having problems with completing daily tasks, comprehension and/or expressing thoughts, please talk with a doctor. Ask your doctor if you could benefit from physical, occupational, or speech therapy.

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Stories from the Field

Featuring HTS Healthcare Hero, Kristen Stedman

Meet Kristen Stedman, a 9-year HTS veteran and a PTA at Ketcham Memorial Center.

Kristen’s healthcare hero status was further solidified by Ketcham’s Administrator, Kathy Wittmer who stated, “We wouldn’t have been able to make it through navigating the PHE without the infection control nurse and Kristen.”

Kristen displayed her commitment to the residents during the PHE in many different capacities. For example, she showed up at Ketcham everyday – regardless if she had therapy patients on her schedule or not. Specifically, Kristen was involved in helping transition patients to ambulances, checking temperatures, and answering call lights to help prioritize patient needs.

Kristen stated the most challenging part of the PHE is knowing residents who became sick and some who even passed away. Oden, Indiana (where Ketcham is located) is a small town. “Since the community is so small, we are like family,” said Kristen. As like many facilities across the nation, Ketcham’s staff pivoted to meet the needs of residents. They adapted and they did so as often as necessary. The therapy team at Ketcham was praised for many reasons with the primary being their ability to change in order to navigate these new COVID-ridden waters.

Now that the initial shock and “pivot” is over, Kristen described some other COVID-related challenges. Restorative is now working in the therapy gym side by “distanced” side. This has required some shift in scheduling. The activities department is now requiring split groups. This also presents a call to action for better communication and organization when scheduling patients attending therapy sessions. All in all, everyone at Ketcham has worked together nicely. As Kristen put it, “For other facilities that are going through this now, it is most important to stick together (with the IDT). Everyone has to work together and you have to be there for each other.”

Thank you Kristen and Ketcham Memorial Center for sharing your Story from the Field!

Past Stories From the Field can be found on the HTS Portal. Have a great “Hoping & Coping Story from the Field ” you would like to share with fellow HTS therapists?

Email Sheena Mattingly, Director of Clinical Outcomes at sheena@htstherapy.com for your chance to be featured in a “Story from the Field!”

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Common Citations During Infection Focused Surveys

Blog by:  Shelly Maffia, MSN, MBA, RN, LNHA, QCP, CHC, Director of Regulatory Services, Proactive Medical Review

Now that routine surveys are beginning to take place in most states, it is important that vigilant infection prevention and control practices do not take a backseat to other survey-ready quality assurance activities. Notably, HHS announced a $2.0 billion payment incentive program (VBP) with $500 million per month for four months Sept. -December 2020 paid based on SNF performance in managing the rate of COVID-19 infections each month and the COVID-19 mortality rate for the month as compared to other facilities with similar community infection rates. Details are forthcoming on the specific formula to be used for distribution of funds, but it is anticipated that a facility may be excluded from receiving a portion of these funds if performing significantly worse than peers on these measures.

Click here to continue reading this blog.

 

About Proactive Medical Review
HTS partners with Proactive Medical Review, a third party company who specializes in ensuring compliance with regulatory standards and promoting measurable care excellence. The team includes SNF experienced nurse, MDS, Health Facility Administrator, therapist and reimbursement specialists with experience serving in multi-site contract therapy operations, as corporate directors of quality, clinical program specialists, and Compliance Officers. Proactive is uniquely positioned to assist in managing the many changes and challenges facing providers partnered with HTS. Learn more about our commitment to compliance here.

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Avoid the Survey Tag (F-866) with Five Simple Steps

By: Sheena Mattingly, Director of Clinical Outcomes

On August 26, 2020 CMS released a memo detailing COVID-19 testing requirements. In order for nursing homes to participate in Medicare and Medicaid, staff and residents need to adhere to new testing requirements. A revised survey tool for surveyors to assess nursing home compliance in this matter is also available.

See below for a list of steps that need to be taken to remain in compliance.

1. Remember, only antigen tests and PCR tests are permitted to be used to meet the testing requirement – antibody tests are not acceptable forms of testing.

2. Testing is based on three different triggers:

Symptomatic Individual Identified

  • Staff with signs/symptoms must be tested
  • Residents with signs/symptoms must be tested

Outbreak

  • Test all staff with previous negative results until no new cases identified
  • Test all residents that previously tested negative until no new cases identified

Routine Testing

  • Test staff according to County Positivity Rate in the past week
  • Resident testing not recommended unless resident leaves the facility routinely

3. Routine testing must be completed of staff according to the table below and is based on the facility’s county positivity rate in the prior week. These county-level positive rates are available here (last modified Sept. 8, 2020). The below table identifies minimum testing frequency related to the county positivity rate within the past week.

*Source: https://www.cms.gov/files/document/qso-20-38-nh.pdf

4. There is a 48-hour time requirement for results of COVID-19 testing. If for any reason, this is unable to be met, the facility should have documentation of efforts to obtain results as quickly as possible. Also, document the lab the facility is using and any contact the facility has had with local and state health departments. Criteria for the inability to meet testing result time requirements may include supply shortages, limited access, or labs failing to process tests within 48 hrs.

5. The newest F-Tag (F-866) is related to noncompliance with new testing requirements. However, if the facility has documentation supporting their attempts to adhere to new testing parameters such as timely contacting state officials and inquiries with labs that can provide results within 48 hours, then surveyors should not tag the facility. Instead, they are to inform state and/or local health departments of the facility’s lack of resources.

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Knee Pain

The knee joint is the largest and most complex joint in the body.  Enduring a significant amount of stress, the knee acts as a support system for our body when sitting, walking, running, and climbing.  The number of moving parts in the knee that makes it so useful also causes it to be vulnerable to injury.

Knee pain is a common complaint that affects people of all ages.  Simple wear and tear and years of walking can cause the knee joint to weaken and become susceptible to inflammation.  While we can’t go back and reverse the damage, there are lifestyle changes you can do now to lessen the stress.

 

Maintain a healthy weight.  Remember that every extra pound adds more strain on your joints and increases your risk of injury and osteoarthritis. 

Keep moving.  Exercise is a great way to alleviate knee pain. Low impact exercises such as walking, yoga, and swimming can help your knees without further damaging the joint.

Increase your strength.  Strength training to build up the muscles in the hip and around the knee joint can help provide support to your knee.

 

How Can Therapy Help?

A Physical Therapist can help you to reduce pain while increasing strength and flexibility to help your body feel and move better.  You will learn what exercises can help your knees without further damaging your joints.

An Occupational Therapist can help you to reduce strain on your joints during daily activities.  You will learn methods to relieve discomfort and improve performance through various physical techniques and activity modifications.

If pain is limiting your ability to perform normal daily activities or participate in activities you enjoy, ask your doctor if Physical or Occupational Therapy is right for you.

 

 

Sources:

https://www.mayoclinic.org/diseases-conditions/knee-pain/diagnosis-treatment/drc-20350855https://www.mayoclinic.org/diseases-conditions/knee-pain

https://www.health.harvard.edu/pain/unlocking-solutions-to-chronic-knee-pain

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Enforcement Cases Held during the Prioritization Period and Revised Survey Prioritization

Blog by:  Shelly Maffia, MSN, MBA, RN, LNHA, QCP, CHC, Director of Regulatory Services, Proactive Medical Review

On 08/17/2020 CMS announced that they are revising guidance on the expansion of survey activities to authorize onsite revisits and other surveys, and guidance was provided to State Survey Agencies (SA) on resolving previously “on hold” enforcement cases. A temporary expansion to the desk review policy was also announced.

Background & Recent Updates

On June 1, 2020 CMS issued survey reprioritization guidance to transition States to more routine oversight and survey activities once a State has entered Phase 3 of the Nursing Home Reopening Guidance. At that time, states were authorized to expand beyond conducting only IJ, Focused Infection Control, and Initial Certification survey, and were permitted to resume the following types of surveys, at the state’s discretion:

  • Complaint investigations that are triaged as Non-Immediate Jeopardy-High;
  • Revisit surveys of any facility with removed Immediate Jeopardy (but still out of compliance);
  • Special Focus Facility and Special Focus Facility Candidate recertification surveys; and
  • Nursing home and Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) recertification surveys in facilities where it has been over 15 months since the last standard survey.

Click here to continue reading this blog.

 

About Proactive Medical Review
HTS partners with Proactive Medical Review, a third party company who specializes in ensuring compliance with regulatory standards and promoting measurable care excellence. The team includes SNF experienced nurse, MDS, Health Facility Administrator, therapist and reimbursement specialists with experience serving in multi-site contract therapy operations, as corporate directors of quality, clinical program specialists, and Compliance Officers. Proactive is uniquely positioned to assist in managing the many changes and challenges facing providers partnered with HTS. Learn more about our commitment to compliance here.

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Stories from the Field

Hoping & Coping:  Smiling Faces

This story from the field focuses on the new “HTS Hoping & Coping Series”. This series emphasizes all the wonderful HTS therapists and the extraordinary lengths taken to assure quality services and patient well-being are maintained during the PHE.

Meet Alexis Jackson, OT and Rehab Manager at Good Sam Home in Evansville, Indiana. Alexis found herself reimagining the work environment during the PHE after watching the May “HTS Lunchtime Learning: COVID-19 & The New Normal”. That very afternoon, Alexis knew The Smiling Faces Initiative described on the webinar was one that would improve morale at Good Sam Home. Smiling face nametags encourage facility staff members to post pictures of themselves on their nametags so that patients are able to more easily identify them and, of course, see their smiling faces! This initiative eliminates a created barrier, real or perceived, between staff and patients. “I feel strongly that our patients deserve to see who we are in order to make a connection that is needed to deliver quality therapy” said Alexis Jackson, OT.

Alexis and the Good Sam Home therapists were the drivers of The Smiling Faces Initiative. Their mission was to bring out smiles from underneath masked faces. First, Alexis trolled Facebook and found pictures of each therapist. Then, after the pictures were included on their nametags, the therapy team began wearing them on a daily basis. “Once we therapists starting wearing smiling face nametags, the initiative just took off!” said Alexis. Soon the facility’s DON, Admission’s Coordinator, Nursing, and Staff Development Coordinator were all wearing a smiling face nametag. We can all use a few more smiles and thanks to the Good Sam Home therapy team, patients are now getting them!

From left to right: Alexis Jackson, OTR/L, Sherri Moore, PTA, Becky Williamson, COTA/L, Rachel Runyon Lortie, OTR/L.

Past Stories From the Field can be found on the HTS Portal. Have a great “Hoping & Coping Story from the Field ” you would like to share with fellow HTS therapists?

Email Sheena Mattingly, Director of Clinical Outcomes at sheena@htstherapy.com for your chance to be featured in a “Story from the Field!”

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Stories from the Field

Featuring Marita Huey, PTA

At age 43, Marita Huey decided to go back to school to pursue a career in which she could serve people within the healthcare space. This journey led her to becoming a PTA. Marita has now been with HTS for seven years!

One of Marita’s newest therapy tricks is the use of The Point of Care (POC) functionality provided by Optima. Marita first was drawn to documentation on POC due to its portability. After a couple uses of the system, she began to understand the user-friendly features which made her more efficient. One of Marita’s pain points, however, is that the goal build function does take longer than what she is used to when documenting on COM (the web-based documentation platform utilized via laptop and desktop). She now typically uses narrative vs the build function which is a blessing in disguise since created goals are now more individualized to meet resident needs.

Another time saving feature Marita described as user-friendly is the ability to bring up all past notes when completing a progress report so the skilled interventions data is able to be easily reviewed. Marita has some advice for new POC users, “Get a peer to help you navigate the Chromebook if you are not techy. Also, it’s a good move to keep a copy of the training manual with you the first one or two times you use POC.”

All in all, Marita is glad to have the use of POC as a documentation option. In a building with a total of nine therapists, there is a possibility to have a device with you to document at all times which in her opinion is a “game-changer.”

Past Stories From the Field can be found on the HTS Portal. Have a great “Hoping & Coping Story from the Field ” you would like to share with fellow HTS therapists?

Email Sheena Mattingly, Director of Clinical Outcomes at sheena@htstherapy.com for your chance to be featured in a “Story from the Field!”

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