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WELCOME TO THE JUNGLE

Denise Spihlman, LCSW, PRSD, CDPOutcome Services of Illinois

THANK YOU FOR BEING A HEALTHCARE HERO !

Thank you for your dedication and hard work

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GOING TO TAKE A WALK ON THE WILD SIDE

• Looking at:Current regulationsRecent changes to regulationsTools to help us carry out our responsibilitiesBeing prepared for surveys (Keeping COVID

restrictions in mind)

GO GET-EM TIGER!

• No one predicted life in 2020 would be this

• Before COVID, I thought social service staff had been stretched as far as they could be – I was wrong.

• It is amazing how in one day we wiped out these past few years of new regulations and reverted back to a time of literally no rights for residents.

• No words to adequately describe how awesome you all are and acknowledge all the sacrifices you have made

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FEELS LIKE THE TWILIGHT ZONE

• Do you wish you would wake up and this would be a bad dream?

• Our industry has been battered with negative publicity at times, the most restrictive of regulations, and serving the most vulnerable population

• Day to day, we hold our breath and hope for no new or no cases, for no new regulations being handed down, and that we are closer to families and residents being able to be together.

TAKING IT DAY BY DAY

• Social media has impacted our industry

• We still have schedules to keep, interviews and assessments to do, discharge planning, and care plans. We hope each day we can get to them

• We have regulations and more regulations, meetings, and more meetings.

• We have FaceTime, phone calls, and visits to fit into our schedules that we didn’t before

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LET’S TALK ABOUT THE ELEPHANT IN THE ROOM

• So many of you have been through all the spectrums of emotions these past several months

• You are exhausted

• As much as you have tried to protect your residents from the virus – it has been just as hard to protect them from despair, loneliness, fear, boredom, anger, and helplessness.

• We all know what they need and in some cases what they needed – but we don’t have a magic wand to fix it all.

• We have to find a way to balance all of these responsibilities we are faced with

NO MONKEY BUSINESS• Current COVID regulations impacting social services

• POLST addendum• Infection Control• Visitor Restrictions• Mental Health needs• Reopening guidelines

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WALK ON THE WILD SIDE –Reopening Guidelines Impacting Social Services• Include visitation policy for each phase in your admission packet

• Your role in scheduling of visits

• Working with families on what can occur with visits and where (depends on what phase you are in)

• Educating residents and families on the phases - what each phase means with what is and is not allowed

• Know what the visitation policy is for each phase

FOLLOW THE BEATEN PATH

• How do you handle when a resident is having a mood decline or behavior change, which could be due to if the home regresses a stage, a family matter or the resident’s emotional needs changing

• Talk with activities about programming for the resident

• Do 1:1 visits (frequency depends on availability and the current mental health of the resident)

• Provide tasks to make the resident feel needed

• Increase communication with family

• Modify care plan

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TAKE TIME TO SMELL THE ROSES –Advance Directives

• The look of the POLST form has changed• Review of how to complete the POLST• Code status needs to be in place at admission• Doctor’s order needs to match POLST. Include Section B on the

doctor’s order.• Care planning (include both A & B from the POLST)• POLST Addendum• Advance Directive Policy

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HEADING INTO THE MAZE• NOMNC has stayed the same

• New ABN form

• PDPM has been in effect for almost a year

• How has it impacted social services?• Changed when we do our interviews• We are more involved with nursing/therapy with

assessing cognitive status• Discharge planning is interdisciplinary and starts

at the time of admission to facility

BE MY GUEST• Use your RAI manual guidance for interviews

• BIMS needs to be done for reimbursement

• Complete within ARD

• Try to do interview at a time to best capture cognitive status

• Some facilities are doing at admission – in case the resident goes to the hospital

• Some facilities are having more than one discipline doing the BIMS

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NO MONKEYING AROUND• Before interviews, need documentation in clinical record

to support how MDS is coded• Look at Section B on MDS• Talk with other members of team to compare cognitive

status observations

• Care plan should have adaptations in approaches due to cognitive status - *Surveyors were looking for this*

FORGET ABOUT YOUR WORRIES AND YOUR STRIFE

• PHQ9• Impacts reimbursement under the nursing

case mix• Score is 10 or higher

• Clinical record should support any mood indicators

• Address mood state on care plan

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IT’S A JUNGLE OUT THERE –Bottomline with PDPM

• Establish discharge plan at time of admission

• Build relationship with resident from admission on

• 72-hour meeting is to get all members of team, resident, and family on the same page

• Accurate interviews

• Document as you arrange services

• Discharge Care Plan – include what all of the departments are working on in order for discharge to occur

• Discharge care plan meeting

• Review discharge documentation with resident

• Give a copy of discharge information to the resident/representative

• Follow-up to see that services arranged have started

SWINGING FROM THE TREETOPS• Transfer & Discharge – F622, F623, F624, F625

• Have a policy in admission packet

• When transferring a resident, need to give written notice of transfer to the resident/resident representative as soon as practicable

• Provide bed-hold policy to resident/resident representative at admission. Need to also send when going to the hospital.

• Notify ombudsman of transfers (can do one time per month)

• If facility is initiating discharge, must notify ombudsman at the time when notifying resident/resident representative

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DENTAL SERVICES – F790 & F791

• Status of with COVID restrictions

• If a resident loses or damages dentures, must refer within 3 days

• Update care plans

• Show how adapting eating for resident

• Dental Policy – Do you have a policy?

TREKKING ALONG –Discharge F660/F661• Start at admission

• Document what the resident wants

• Reflect resident’s wishes regarding discharge on baseline care plan

• Do you want to talk with someone about the possibility of returning to live in the community?

• Get input from resident and family on wishes and reflect on care plan

• Include discharge status on comprehensive care plan

• Change care plan when resident/resident representative wishes change or when status of resident changes

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THE JOURNEY STARTS HERE –Baseline Care Plans – F655

• With COVID restrictions in place, how are you modifying to share this inf0rmation with resident and family

• Within 48 hours of admission

• Social services• Code status – Make sure you check the baseline care plan that it matches the POLST• Elopement risk• Discharge• Psychotropic medications• PASRR recommendations • Meet with resident/family to go over care plan and provide a summary• Document how you did the review

HEAR THE ROAR OF THE LION –Grievances – F585• Policy in admission packet

• With COVID restrictions, how have you adapted – How can they file anonymously? Where are the papers to fill out?

• Is the grievance official easily accessible/available?

• Action plan – Steps taken to fix grievance

• Meet with resident and document if satisfied

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ON SAFARI –Behavioral Health Services – F740-F745• Education & Programming

• Staffing

• Non-pharmacological approaches

• Dementia care, trauma-centered care

• Care plan is key

• While may not be a focus from a survey standpoint, it is a priority area

THE CALL OF THE WILD –Trauma-Centered Care – F742 – F744

(Behavior Health Services)

• Regulation started November 28, 2019

• It has been almost a year since this regulation started and where are we?

• What should we be doing

• Use the Trauma (Life Experiences) Checklist at admission, at initial care plan meeting, and when a new behavior occurs

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• Use the Trauma Checklist (Life Experiences Checklist) at admission and review when a new behavior occurs

• Document on the social history any trauma information you receive – do upon admission and anytime you receive information on a trauma

• Always be on the lookout that any mood/behavior could be due to a trauma in past – ask questions of family/resident

• Make sure you have a policy that reflects meeting mental health needs of residents and includes trauma-centered care

• Incorporate information regarding the trauma on the care plan

• Educate staff both regarding individual residents and traumas as well as how staff should handle residents’ emotional needs overall

• 1:1 visits based on resident need (at least PRN) and some residents may benefit from psychosocial groups or outside counseling services – These may need to be modified depending on COVID restrictions in your facilities

• Be prepared – watch for signs that approaches are not working and changes to care plan need to be made.

• Provide ongoing training to staff as current restrictions can be traumatizing for residents and staff

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HEADING INTO THE FRONTIER

• An event becomes traumatic when the ability to cope is overwhelmed or previous ways to cope no longer work (life for many of us and our residents)

• We don’t want to re-traumatize our residents

• People with dementia who have experienced a trauma in the past may relive the trauma multiple times a day

• With the focus on infection control and resident safety, this has been lost

KING OF THE JUNGLEDementia Regulations – F744• Check that you have in place–

• Have a policy• Complete staff training• Adapt to cognitive ability• Have programming in place (many have stopped due to COVID)• Know how are you planning to adapt• Have a care plan in place (cognitive status, modified programming)

• Dementia Surveys were occurring before COVID• Alzheimer’s Disease and related Dementia Services Act (Il Admin.

Code 973.100-150) went into effect May 23, 2019

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THE RIVER’S EDGE Medically-related Social Service Needs – F745

• The facility must provide medically-related services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident

• What does this mean (examples)• Advocating and assisting them with their rights• Help with grievances, visitations, living arrangements and accommodation of needs• Help with educating residents and families on healthcare option• Assisting with obtaining clothing and personal items• Helping with mental health needs• Meet needs of residents who are grieving from losses and coping with stressful events.

DON’T WAKE A SLEEPING BEAR–Psychotropic Medication – F757 – F758

• Medication history (social history)

• Psychotropic medication assessment

• Consent

• Tracking

• Care plan

• GDR

• Policy

• Non-pharmacological intervention

• Behavior management meetings

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RUMBLE IN THE JUNGLEResident Rights – F550 – F586•Key ones –

•Make treatment decisions•Participate in planning care•Visitors•Room/roommate changes

BIRDS OF A FEATHER

• QAPI

• Infection control – work with your infection preventionist

• Use your facility assessment

• Make sure care planning COVID restrictions• Resident won’t wear a mask – goes on care plan

• Monitor for abuse/neglect

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NAVIGATING THE TERRAIN

• Status of Subpart S

• Medicaid Reimbursement

• Identified Offender Program (312-793-0529)

THE RIVER FLOWS THROUGH IT

• Trainings to focus on –• Effective communication• Resident rights/facility responsibilities• Dementia management• Freedom from abuse/neglect and exploitation• QAPI• Infection control• Compliance

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BARE NECESSITIES –Social Service Documentation• Varies Per Home

• Policy On COVID Restrictions (Visitation)

• OBRA/Pas Screen (Check It)

• Subpart S Screener

• POLST Form

• Resident Rights

• Social History

• Evaluate For Trauma-centered Care

• Discharge Planning

• Social Service Evaluation (For Medically-related Social Service Needs)

• MDS Sections (Typically C, D, E, Q)

• CAAS

• Supplemental Assessments (Elopement, Smoking, & Abuse are examples)

• Care Plan Invites

• Behavior Tracking

• Incidental Notes• Quarterly Notes• Documentation for Identified Offenders • Subpart S

• Care Plans (Includes Baseline)• Advance Directives• Discharge• Mood• Behavior• Reason resident was placed on the psychotropic medication• PAS• COVID restrictions• Trauma

Survey Trends (Pre-COVID and COVID Surveys)

• OBRA screens not done before admission or incomplete• PASRR recommendations not followed through on care plan• Baseline care plans not having goals and giving resident a

copy not being done• Lockbox for grievances and a way to file grievances• Not identifying code status at admission and not on baseline

care plan• Physician orders do not match POLST• Not providing notice of transfer to resident/representative

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Survey Trends Con’t• Not giving ombudsman notice of resident transfers

• Not providing bed hold policy at transfer

• Not giving the NOMNC form

• Behavior tracking not completed accurately and not individualized to the resident

• Staff not following care plan when dealing with resident behavior.

• If facility initiates discharge, need to notify ombudsman when notifying resident

• Not explaining COVID visitation policy to resident/family

• Not adapting care plan approaches to cognitive status

• Not addressing new behavior on care plan

• No documentation of attempts to change behavior prior to use of psychotropic medications

• Facility-initiated discharges did not have notification in timely manner to resident/representative and ombudsman

• No documentation of services set up for discharge

• Resident required transfer/discharge to another facility and staff did not assist with optional placements.

SURVEY READINESSTOOL

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THANK YOU FOR YOUR TIME TODAY

Please contact me if you have any questionsDenise Spihlman, LCSW, PRSD, CDP

618-210-7469denise@outcomeservices.com

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