Category: Clinical

May plays host to both National Skilled Nursing Care Week (NSNCW) and Better Hearing and Speech Month (BHSM). Although this planning may not be intentional, the themes of each celebrate their profession’s role in human connection. NSNCW’s theme of “Creating and Nurturing Connections” and BHSM’s theme of “Connecting People” could not be better timed to raise awareness and celebrate these distinct, yet entwined, professions.

Every member of the skilled nursing care team is a vital part of building connections within that facility. Oftentimes for residents, these settings are new and unfamiliar, leading to isolation and the potential for depression. Front-line healthcare workers have been instrumental in helping residents cultivate meaningful relationships, leading to improved comfort and quality of life. Opportunities for authentic, mutual connections present in different ways and allow for meaningful relationships between residents and staff to occur organically and naturally strengthen.  It is through these daily interactions with residents, families, and each other, that positive connections have been established and fostered. These connections are needed to create moments of joy and purpose for both staff and residents.

For the staff who provide encouraging smiles when the resident first arrives at the facility, the CNA who always remembers a resident’s favorite sweater, the social worker who holds a resident’s hand reassuringly and listens, the dietary aide who never forgets that a particular resident only likes Cornflakes for breakfast, the housekeeping staff member who pauses to discuss a resident’s predictions for this baseball season, the nurse who takes the extra time to help a resident Skype with her daughter, and the speech-language pathologist who ensures a resident is able to confidently voice their wishes during a care plan meeting – a week, or even a month of celebration simply does not feel adequate. These are the moments of creating and nurturing connections that should be celebrated daily. This month and every month, we applaud our teams for their role in connecting and linking the human spirit in facilities across the nation.

Since the Omnibus Budget Reconciliation Act (OBRA), or the Nursing Home Reform Act of 1987, federal standards have been in place to regulate efforts to address a resident’s quality of life (QOL). These federal standards identify six principles of QOL, including: sense of well-being, satisfaction with life/oneself, self-worth/self-esteem, satisfaction with environment and care, goals, and control. New data gathered during the COVID-19 era highlights the necessity to prioritize QOL, revealing that adverse effects of isolation have resulted in cognitive, psychosocial, and physical decline for many in post-acute care settings.

Because QOL is a multi-dimensional concept, this essential component of health and wellbeing should be addressed through the comprehensive efforts of an IDT. Each member of the IDT plays a distinct role to promote a resident’s QOL. Consider implementation of some of the following interventions for improved QOL within your facility:

• Identify resident-specific interests and provide opportunities for participation in these activities on a regular basis. Consider virtual leisure opportunities, as well.
• Improve the resident’s health literacy to promote wellness and prevent future injury/illness.
• Execute environmental modifications that promote greater participation for all residents in activity groups.
• Implement a facility-wide screening process for identification of depressive symptoms in residents.
• Offer scheduled check-ins to allow residents the opportunity to present questions/concerns.
• Consult with key players to identify activity groups, community outings, events, speakers, and responsibilities that could serve as opportunities for resident participation.
• Provide stress management and relaxation strategies for residents and healthcare workers in the facility.

As experts in analysis of performance and participation, PT, OT and SLP can assist in assessing the resident’s functional abilities and tailoring interventions, like those listed above, to achieve person-centered goals. With the unique lens and contribution of each additional member of the IDT, these interventions can become reality; ultimately maximizing QOL, functional outcomes, and patient satisfaction.

As skilled nursing facility providers and caregivers, we are privileged to experience many of the fruits of our patient’s progress during their stay, directly related to the services and care that we provide. We are able to share in the excitement and pride that accompanies progress towards a safe discharge to the next level of care after sustaining an often times life-altering injury or health-related episode. But what about life after discharge from our care? Are we confident that our patients and their caregivers are equipped to maintain their progress and successful outcomes, on their own?

The healthcare community, including the Centers for Medicare and Medicaid Services (CMS), emphasizes the importance of interdisciplinary, comprehensive discharge planning from the time of the patient’s admission. Recent literature suggests that the interdisciplinary team (IDT) is able to reduce hospital readmissions and facilitate successful outcomes beyond discharge through provision of high-quality discharge information, participation of the patient and caregiver in the discharge process and focus on increasing the patient and caregiver’s understanding of the discharge information (Hesselink et. al, 2014).  All skilled nursing providers play an important role in the interdisciplinary approach to discharge planning, and a collaborative partnership between therapy, facility staff, case managers, family, and the patient is paramount to success. The weight of the interdisciplinary team’s commitment to patient and caregiver preparation for the next level of care cannot be overlooked. Consider these key components of discharge planning throughout the patient’s stay:

•  Upon admission:
  • From the time of admit, discharge plans should be considered. Goals should be developed and updated to ensure preparedness for the setting, level of assistance, and needs anticipated at discharge.
• Throughout the episode of care:
  • Consider a system to ensure all staff are aware of the patient’s personal goals. Implement ongoing patient/caregiver education for health literacy, functional targets, and training to allow ample time for questions, problem solving, and repetition prior to time of discharge.
• At time of discharge:
  • Provide clear, comprehensive, and accurate information regarding the patient’s discharge level of function, recommendations for equipment or follow-up care, and level of assistance or supervision for daily tasks. Enable the patient and caregiver’s understanding of skilled staff recommendations.

Reliant has created proprietary resources to guide clinicians through comprehensive, effective discharge planning. These resources can also facilitate education, trainings, and increased opportunity for IDT discussion.  Check out Reliant’s Discharge from Therapy to Community Packet and Discharge from Therapy to Nursing Packet to ensure that your patients and caregivers are properly prepared for the next level of care.

With effective discharge planning that occurs throughout the patient’s episode of care, we can facilitate carryover of learned strategies, patient and caregiver confidence, reduced risk of rehospitalization and successful outcomes beyond discharge from therapy.  Reliant is proud to partner with you to confidently guide our patients, caregivers, and staff through discharge planning that will lead to patient success beyond discharge!

References

Hesselink, G., Zegers, M., Vernooij-Dassen, M., Barach, P., Kalkman, C., Flink, M., Öhlen, G., Olsson, M., Bergenbrant, S., Orrego, C., Suñol, R., Toccafondi, G., Venneri, F., Dudzik-Urbaniak, E., Kutryba, B., Schoonhoven, L., Wollersheim, H., & European HANDOVER Research Collaborative (2014). Improving patient discharge and reducing hospital readmissions by using Intervention Mapping. BMC health services research, 14, 389. https://doi.org/10.1186/1472-6963-14-389

As the occupancy of residents in our facilities begins to rebound, labor challenges appear to be one of the biggest dilemmas nursing home operators are facing. With staffing shortages, it may be difficult to implement optimal programming; however, as healthcare professionals in skilled nursing we are governed by the overarching concepts of quality of life, quality of care, and patient-centered care that are present in the 2016 Medicare and Medicaid Program Reform of Requirements for Long Term Care Facilities (81 FR 68688). These requirements provide the minimum framework of effective care regardless of resource availability or staffing.

Facility staff members should feel empowered to live a culture that improves resident’s quality of life and promotes healthy aging.  Providing extra “care on the move” throughout the day while performing usual daily tasks makes a tremendous difference and allows facilities to meet federal requirements.  Providing “care on the move” allows facilities who are facing staffing challenges or inconsistent program execution to meet residents’ needs and potentially document their “moves” on the MDS.

A key element at the center of this quality-of-life promotion is emphasizing resident’s ability versus disability and capitalizing on what the resident can do over what they cannot.  Some examples of “care on the move” that take advantage of improving or maintaining abilities include:

• Allow any resident who is able to ambulate short distances or propel themself in their wheelchair, to mobilize to and from daily weight checks.
• Use daily assist with dressing and grooming as a time to incorporate effective communication by allowing time for conversation and encouraging the resident to express wants/needs, and complete tasks as independently as possible.
• When a resident is toileting, provide encouraging verbal cues versus automatic physical assist, as much as safely possible, to allow for maximal independence.
• Utilize bed mobility and transfers with a resident as an opportunity to encourage the use of bed rails; and to provide training for rolling, supine to sit, and positioning themself in bed.
• Use the facility PA system to elicit facility-wide range of motion activities. For example, when music is played, all restorative trained staff take time to assist with range of motion goals or perform sit to stand activities with the residents.

The moments spent reinforcing residents’ abilities builds both resident and staff confidence and satisfaction, and ultimately improves quality of life. For those facilities that have restorative nursing programs in place, “care on the move” is an additional avenue to promote the health and wellness of residents. In the face of challenges, we must do our part to ensure that our residents’ care needs come first. Lead the way with your interprofessional team by providing your residents those extra moves that make a difference!  

The field of speech pathology grew in the 1920s as clinicians began to work with soldiers, returning home from World War II, suffering from brain injuries. Since then, speech and language pathologists (SLPs) have helped countless individuals as experts in the field of communication, swallowing disorders, and cognitive impairments in a variety of settings.

As we celebrate Better Hearing and Speech Month, we recognize SLPs and acknowledge their immense influence in improving the quality of our residents’ lives and being key members within our interdisciplinary teams (IDT).

With the introduction of the patient driven payment model (PDPM) in recent years, SLPs are now more than ever actively engaged with the IDT to ensure the MDS accurately portrays the residents’ clinical characteristics and skilled need. Since SLPs are qualified leaders in the areas of cognitive-linguistic impairments and dysphagia, including them in conversations as the MDS coordinator completes sections C, K, and I, can improve the accuracy of these assessment areas, as accuracy of the MDS remains a critical component of the PDPM and ensures resources are available for each resident’s unique needs. By working with the nursing team, SLPs also provide a multi-disciplinary approach to patient care that is focused on patient outcomes, ensuring both quality of life and quality of care expectations are exceeded.

Recently, as a result of SNFs receiving an unintended increase in payments,  CMS has expressed its intention of recalibrating the PDPM “as quickly as possible,” in an attempt to restore it to the original budget-neutral goal. As CMS continues to monitor PDPM and its effects on payments, the IDT will need to ensure accurate and thorough medical documentation is present within the patients’ charts. Due to a sharp change in utilization for speech resources, CMS will be reviewing cases to ensure that speech services were directly linked to a doctor’s order, such as for patients with swallowing issues who require a modified diet.

This month we pause to thank our SLPs and their dedication. Since the inception of the field of speech and language pathology, SLPs continue to rise to the challenge daily. Staying abreast of the latest advances in their field including regulatory changes and requirements, they continue to advocate for the necessity of speech language pathology interventions for the safety and well-being of individuals. SLPs remain a valuable asset to the IDT as a facility leader in dysphagia management, communication and cognitive interventions, and patient and caregiver education.