Monday, July 22, 2013
Most seniors live in a temperature controlled setting, whether at home or in a skilled or assisted living facility, but during the warmer months, seniors may spend more time interacting outside where temperatures are hot.
Care givers will often take advantage of the warm weather to get seniors outside whether for special activities or just for a break from the senior’s daily routine, but this puts the senior at risk.
As a result, care givers need to be mindful and aware of the signs and symptoms of dehydration and heat-related illness and implement interventions to prevent their occurrence.
Physical symptoms of dehydration include:
• Cracked lips
• Flushing of skin
• Dark urine
• Low urinary output
Behavioral symptoms of dehydration include:
• Increased agitation
• Increased confusion or restlessness
Interventions to prevent dehydration include:
• Providing access to clean fresh cold water.
• Using water bottle holders or bottles with straws for residents who spend most of the day in a wheelchair.
• Offering a wide choice of fluids throughout the day.
• Offering high water-soluble foods like sherbet, Jell-O and Popsicles.
Like dehydration, care givers should be aware of the following signs and symptoms of heat-related illness:
• Heavy sweating
• Muscle cramps
• Nausea or vomiting
• Skin: may be cool and moist
• Pulse rate: fast and weak
• Breathing: fast and shallow
Interventions to prevent heat-related illness include:
• Planning outdoor activities for early morning or late evening when it’s cooler.
• Taking breaks when working outside. Use shade whenever possible.
• Wearing sun block, hats and light-colored, loose-fitting clothes.
• Keeping drinking at regular intervals and increase the amount consumed.
Also don’t forget that with the first signs of dizziness, nausea, headaches, or muscle cramps, move the senior to a cooler place, have the senior rest for a few minutes, then have the senior slowly drink a cool beverage.
If you haven’t already done so, make sure you and your staff are trained on dehydration and heat-related illness. Check out our courses for more information:
Fluid Replacement: The Danger of Dehydration (P1074)
Disaster Preparedness Series: Extreme Heat and Cold (P1155)
Jennifer Moore, RN
Thursday, July 11, 2013
In the new update the OIG describes the legal prohibition of submitting a claim or receiving a payment from a Federal health care program for items or services such as direct patient care, indirect patient care, and administrative and management services, or receiving medical direction or a prescription from a person on the federal exclusion list.
Are you or someone you work with excluded?
The OIG defines an excluded person as someone who they have excluded from participating in Medicare, Medicaid, and other Federal health care programs after finding that the person has engaged in fraud, abuse, or other misconduct relating to Federal health care programs. In January of this year, Care2Learn hosted a webinar What's New in 2013 - Regulatory Updates, on that webinar we detailed three ways you can and should check whether someone on your staff or a partner with whom you work is on the Federal exclusion list for more information go to:
1. SAM (System for Award Management): http://sam.gov
2. LEIE (List of Excluded Individuals and Entities): http://oig.hhs.gov/fraud/exclusions/exclusions_list.asp
3. State Medicaid sites if applicable
Be sure to be thorough!
It is also recommended that you check the exclusion list on a monthly basis. The OIG updates the LEIE monthly, so screening employees and contractors monthly will minimize potential CMP liability. For example, you may conduct an exclusion check on a new employee in March of 2013 and find that they are not on the system at that time. If you wait until the following year to check again, you may find out that the person was put on the exclusion list in April 2013 and now you have employed an excluded person for almost a year.
Unfortunately, ignorance will not get you anywhere and if you are found to be employing or doing business with someone on one of these lists, you will pay the price. The Updated Bulletin states that if you arrange or contract a person that you know or should have known was excluded by the OIG, you may be subject to a Civil Monetary Penalty (CMP). A CMP may be up to $10,000 for each item or service furnished by the excluded person for which Federal payment was requested as well as an assessment of up to three times the amount claimed. Additionally, on top of the CMP, the OIG may then exclude you from participating in Federal health care programs.
The OIG asserts that it is the provider’s duty to check the exclusion status of individuals and entities prior to submitting claims for payment for items or services the provider has furnished.
Be sure to Prove that you Checked!
Just to cover your bases, we also recommend that you keep records that you performed a search to ascertain whether or not a person or a vendor was on the exclusion list. Print or take screen shots of searches performed and be sure to capture time and date stamps!
Mistakes do Happen
After all that, it does happen where you didn’t see someone’s name until after the fact and you’ve already submitted a claim for payment from a Federal health program the OIG encourages you to proactively participate in a Self-Disclosure Protocol to disclose the violation.
Cheryl Swann, RN-BC, BSN, WCC, LNHA
Vice President of Content
Monday, June 24, 2013
- QAPI at a Glance – a guide for understanding and implementing QAPI in nursing homes
- QAPI Tools – process tools, within QAPI at a Glance, to help providers establish a foundation in QAPI
- QAPI News Brief – a newsletter describing basic principles of QAPI
- Video – Nursing Home QAPI – What’s in it for you? - introduces QAPI, its value to residents, their families and caregivers, and what is in it for nursing homes that embrace QAPI
Tuesday, May 14, 2013
The Affordable Care Act’s mandate for payment reductions for hospitals with high rates of readmissions is heading toward the post-acute industry.
The U.S. Department of Health and Human Services (HHS) 2014 budget proposal includes a Medicare legislative proposal that could save $371 billion over ten years and smack in the middle of that proposal is a recommendation that would impose payment reductions to skilled nursing facilities for preventable hospital readmissions.
Told you so!
HHS references research by the Medicare Payment Advisory Commission that notes that nearly 14 percent of Medicare patients that are discharged from a hospital to a post-acute setting – primarily a skilled nursing facility -- are readmitted to the hospital for what they consider avoidable care issues. The budget proposal is recommending that beginning in 2017, payments made to post-acute/skilled nursing facilities be reduced by 3% for facilities that have high rates of preventable hospital readmissions.
But it’s not your fault! Right?
Unfortunately that argument is not going to resonate. Right now, hospitals are tracking patients they discharge, noting where they are being discharged to and whether they are being readmitted back to the hospital. They are literally tracking utilization figures of nursing facilities because they have to report their rehospitalization rates to Medicare.
It is just a matter of time until the hospital is going to report to Medicare the names of the skilled nursing facilities that contribute to high rehospitalization rates, and that is when it’s going to affect you, the nursing facility. Medicare will note your rehospitalization rate and penalize you. Thus the 3% reduction begins.
As a skilled nursing facility you may logically try to explain that the rehospitalizations came as a result of physician’s orders, non-compliant patients, and so on and so forth. It’s not your fault. But the finger pointing will only get you so far. The hospital will start to select facilities that they know can provide quality in-house care to higher acuity patients, therefore preventing rehospitalizations.
Is your staff trained to reduce rehospitalization? Can your staff ensure that the hospital has provided the necessary information regarding the patient’s plan of care prior to admission? Are they trained to care for the diseases and conditions most associated with rehospitalizations? And finally, do they have the skills required to provide the quality care needed to prevent rehospitalization? If you can’t answer yes to these questions, you may be looking at a 3% reduction in your bottom line in addition to a lower census since your hospital partners might just stop referring patients to you.
Check out our Reducing Rehospitalization Series of courses and our Rapid Review Series which will provide your staff the knowledge needed to prevent rehospitalizations so you can say YES to your hospital referral network!
Cheryl Swann RN-BC, BSN, WCC, LNHA
VP of Clinical Services
Thursday, April 25, 2013
- Ensure that you receive a list of current medications.
- Obtain a list of all prescribed medications.
- Compare both lists and ask questions to reconcile the two.
- Make a decision regarding which meds to continue based on medical judgment, patient condition, and patient history.
- Communicate the med list to all caregivers, family members and the resident.
Tuesday, April 9, 2013
Tuesday, March 26, 2013
Check out our courses:
Understanding the Meaning behind Behaviors: Actions & Reactions
Psychotropic Medications: Antipsychotics and Beyond