Staff Work Schedules: It’s Time to Get Flexible—and Realistic—to Improve Retention

Flexible scheduling, which allows staff members to opt for shorter shifts, longer shifts, add-on shifts, and other staffing flexibilities, can be a strong tool for both recruitment and retention in long-term care, says Jasmine Travers, PhD, MHS, RN, AGPCNP-BC, assistant professor at the New York University Rory Meyers College of …

Staff Performance: When Expectations Don’t Match Reality

To implement the minimum nurse staffing standards for registered nurses (RNs) and nurse aides (NAs) and the increased on-site RN requirement in the Minimum Staffing Standards for Long-Term Care (LTC) Facilities and Medicaid Institutional Payment Transparency Reporting final rule starting as early as May 2026 on some requirements for urban …

Substance Use Disorders: What the DNS Should Know

Over 1 million people aged 65 and over live with substance use disorders (SUD) (Alliance for Aging Research, 2022). As with most trends, what is prevalent in the community will also be prevalent in nursing homes. Therefore, the director of nursing services (DNS) should understand the nuances of this disorder …

Preferences and Routines: Use Section F to Collaborate on the Care Plan

The Resident Assessment Instrument (RAI) process begins with the Minimum Data Set (MDS) assessment and ends with the resident-centered comprehensive care plan. In the MDS, section F focuses on the resident’s preferences for customary routines and activities, asking scripted questions about how the person rates the importance of these items. …

Skilled Observation and Assessment Hinges on a Reasonable Probability of Complication

Direct skilled services under Medicare Part A often are easy to identify because these services involve specific, complex caregiver-to-resident actions. Their “inherent complexity” means that they can “be performed safely and/or effectively only by or under the general supervision of skilled nursing or skilled rehabilitation personnel,” explains the Centers for …

Care Plan Management and Evaluation Can Be a Skilled Service for At-Risk Residents

The development, management, and evaluation of the resident care plan is the OBRA backbone of the Resident Assessment Instrument (RAI) process for all residents regardless of payer source, so it may surprise some nurse assessment coordinators (NACs) and directors of nursing (DNSs) to learn that care plan management and evaluation …

How to Use the ICD-10-CM Coding Manual

Since the start of the Patient-Driven Payment Model (PDPM) in October 2019, the International Classifications of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) has been thrust into the forefront of daily tasks for the nurse assessment coordinator (NAC). ICD codes were always applied in long-term care (before 2015, ICD-9-CM codes were …

Burnout, Compassion Fatigue, and Moral Injury: Keys to Prevention and Mitigation

Protecting and supporting the nursing home workforce is not optional—it is the daily work of managers and leaders, says Patricia McGaffigan, RN, MS, CPPS, senior advisor for safety at the Institute for Healthcare Improvement (IHI), president of the Certification Board for Professionals in Patient Safety, and co-chair of the National Steering …

F689 Accident Survey Citations: What’s Behind These Immediate Jeopardies?

F-tag 689 (Free of Accident Hazards/Supervision/Devices) was the No. 1 tag cited at the immediate jeopardy (IJ) level in 2023—and remains at the top halfway into 2024, according to QCOR data accessed on June 30, 2024. In many ways, F689 is a catch-all tag, says Angie Szumlinski, LNHA, RN, GERO-BC, …

Taking the Mystery out of the Facility Assessment

Everyone loves a good mystery. Many like to watch their favorite mysteries on television or read a good thriller. However, mystery and suspense should not be a part of the facility assessment review. The final staffing rule released in April 2024 requires all facilities accepting Medicare and Medicaid payments to …