DOH Provides Updates on Various Key Issues
At a regularly scheduled Department of Health (DOH) and Nursing Home Association meeting held on Oct. 26th, DOH provided updates on a number of key issues. The meeting is held quarterly with Sheila McGarvey and Mary Jane Vogel from the DOH Office of Aging and Long-Term Care. The discussion included updates on the following:
DOH COVID-19 Guidance: On Oct. 13th, DOH issued COVID-19 guidance on a number of areas including testing, cohorting, and visitation. DOH has received a number of questions and is in the process of preparing a Frequently Asked Questions (FAQ) document to respond to the questions raised by the provider community.
Staffing Legislation: DOH could not report on the recently passed minimum staffing regulations. However, they did acknowledge that many of the issues are being discussed at the highest levels of the Department and that guidance would be issued at some time in the near future.
Phase 3 Requirements of Participation: Centers for Medicare and Medicaid Services (CMS) QSO-22-19-NH, outlining the changes to the survey guidance, was discussed. The changes will be implemented effective Oct. 24, 2022. All of the survey tools, including Appendix PP and Chapter 5 of the State Operations Manual (SOM), have been updated. A number of the Critical Element Pathways have also been modified. There will be some additional focus on some areas such as mental health, substance use disorders, and unsafe smoking. Surveyors have been receiving significant training in the new guidance changes. However, DOH did acknowledge that there will be a learning curve and that if concerns are noted about the process during a survey, providers should reach out to their regional office for clarification.
Complaints: DOH has instituted a revised complaint process that includes the introduction of a CMS form intended to be used as a follow-up investigation form. A revised triage process has been instituted as well. DOH has urged providers to be as complete and accurate on the follow-up investigation form as possible, as in some instances, based on the form, a case might be able to be closed out quickly. Lack of information could possibly prompt an on-site investigation. DOH cautioned that all allegations should be investigated and that there have been instances where nursing homes, based on the cognitive level of the resident, speculated that the incident may have not happened and therefore did not investigate the allegation. The Nursing Home Incident Reporting Manual currently online is to be removed. DOH expressed that the federal reporting process does not fully cover elopement or physical environment issues (loss of heat/air conditioning). These will still be required to be reported. Many of the citations issued over the last year were the result of incomplete investigations. DOH raised some concern about misappropriation and the need to investigate all incidents regardless of the dollar amount missing or the item taken.
TNA to CNA Transition: There are still a fairly large number of individuals not certified due to scheduling/testing issues. DOH is working closely with Prometric to reduce the backlog. The State received a waiver that allows individuals to work beyond four months without certification. This waiver ends when the federal Public Health Emergency (PHE) is declared to be over. DOH urged providers to be aggressive in pursuing testing for that reason. Some facilities have provided incomplete applications that have delayed scheduling. Additionally, there have been a fairly high number of people who have had to be retested, and DOH is concerned about the fail rate.
Citations: Based on recent data, the most cited deficiencies are Accidents (lack of supervision), Failure to Report and Investigation of Allegations, Comprehensive Care Plans, Abuse/Neglect, Food Stored/Served in Sanitary Manner, Infection Control, Homelike Environment, and Advance Directives.
Schizophrenia Surveys: CMS is conducting pilot surveys (off-site) that are looking at a number of factors related to schizophrenia. Findings have included a lack of assessment, lack of justification for medication, no gradual dose reduction (GDR) efforts, inconsistencies in the Minimum Data Set (MDS), lack of documentation of behavior, and no diagnosis prior to admission.
Contacts: Elliott Frost, efrost@leadingageny.org, 518-441-8761 and Amy Nelson, anelson@leadingageny.org, 518-867-8383 ext. 146