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2014 MDS OBRA Assessment Scheduling Calendar
Shows the next assessment date for each one of the 365 days of the year.
Long term care Restorative Nursing programs will see some big changes with the expansion of Medicare to cover Maintenance Therapy.
“Coverage of skilled nursing and skilled therapy services does not turn on the presence or absence of a beneficiary’s potential for improvement, but rather on the beneficiary’s need for skilled care.” CMS announced this week.
“Skilled care may be necessary to improve a patient’s current condition, to maintain the patient’s current condition, or to prevent or slow further deterioration of the patient’s condition. The concept of skilled therapy services can similarly involve not only services that are restorative in nature but, if certain standards are met, maintenance therapy as well.”
Maintenance Therapy is justified, says CMS, to prevent or slow a decline in condition.
Previous standards required that skilled nursing services result in an improvement to a resident’s condition to qualify for Medicare reimbursement.
Maintenance Therapy and Restorative Nursing Manual Updates to Clarify Skilled Nursing Facility (SNF), Inpatient Rehabilitation Facility (IRF), Home Health (HH), and Outpatient (OPT) Coverage, Department Of Health And Human Services, Centers for Medicare & Medicaid Services, Implementation Date: January 7, 2014
FAQ: Medicare Beneficiaries May See Increased Access To Physical Therapy Or Some Other Services, Kaiser Health News
As the demand for caregivers in long term care increases, fewer people are drawn to caregiver positions. The ratio of twenty residents to one CNA is now common, preventing any possibility of adequate care, job satisfaction, or staff retention.
“More than 1.3 million new paid caregivers will be needed to meet demand over the next decade,” according to a recent New York Times article.
The article also cites low wages and Medicare / Medicaid funding deficits as factors contributing to the problem.
This critical situation is not being acknowledged or addressed by government agencies. The Center for Medicare Advocacy states in a recent report that “the federal enforcement system cites very few facilities with staffing deficiencies and often does not impose any financial penalties, even when it finds that facilities do not have sufficient staff.”
A Shortage of Caregivers, New York Times Article
Center for Medicare Advocacy Report
The nursing care plan goal can be to prevent a potential problem from occurring, to maintain a present status or level of functional ability, or to resolve a currently existing problem. Goals are usually stated in terms of an action the resident will perform. Elements to focus on in writing the goal are that it is:
Appropriate – for the resident’s needs, strengths, abilities, and cultural background
Realistic – reasonably attainable
Measurable – able to be objectively observed and evaluated
Resident centered – stated in terms of the resident’s actions
Time framed – gives a target date or time estimate for attainment of the goal
Individualized – to the resident’s unique deficits, traits, and preferences
Specific – each problem has a goal specific to it, although each problem may have more than one goal
Resident will wash face and hands during morning care every day.
Resident will verbalize understanding of the need to comply with diabetic diet.
Resident will lose one pound per week over the next thirty days.
Read more about how to write nursing care plans in the book Complete Nursing Care Plans for Long Term Care - 143 nursing care plans in the book and on the CD can be made resident specific and converted to I-care plans in one click.