Long Term Care Competency Programs – Get Staff Input to Avoid Citations and Other Problems

The third and final phase of the Centers for Medicare and Medicaid (CMS) Final Rule, Medicare and Medicaid Programs: Reform of Requirements for Long-Term Care Facilities, is meant to close the loop on many operational improvements. Specifically, this regulation has been put in place to ensure that a facility’s QAPI (Quality Assurance and Performance Improvement) plan and assessment plan is in place and working well. So, how does it accomplish this goal in the real world? 


Although still in its early days, the rule aims to meet this goal by ramping up site evaluations around compliance and ethics. That means if a facility is lagging on getting its QAPI and competency assessment house in order, there could be trouble. For instance, there could be violations that can easily cascade into each other and mount up quickly, says Tracey Cooley, RN, BSN, a master trainer and surveyor and Vice President of Training at HealthStream.  


“Even if you get just one F-tag for an issue, such as an F880 for infection control, this could also link back to a training and competency issue which could result in another tag,” explains Cooley, who has held numerous positions within long-term care including director of nursing, restorative nurse, assessment coordinator and staff nurse, as well as serving as a healthcare surveyor with the Ohio Department of Health. “You can expect training and competency to climb the ranks in frequently cited F-tags because each one of the 10 top cited F-tags, again, depending upon the content of the citation, could link back to a deficiency in training and competency.” 


Those top 10 F Tags, according to an August 2019 Nursing Home Care update, are: 


  • F880: Provide and implement an infection prevention and control program 

  • F812: Procure and store, prepare and serve food in accordance with professional standards 

  • F689: Ensure that a nursing home area is free from hazards and provide supervision to prevent accidents 

  • F656: Develop and implement a care plan that meets needs with timetables and measurable actions 

  • F684: Provide appropriate treatment and care according to orders, resident’s preferences and goals 

  • F761: Ensure drugs and biologicals are labeled and stored 

  • F657: Develop the complete care plan within 7 days of the comprehensive assessment 

  • F758: Implement gradual close reactions and non-pharmacological interventions, unless contraindicated 

  • F550: Honor resident rights re: dignified existence & self-determination 

  • F641: Ensure each resident receives an accurate assessment 


“The facility assessment and competency plan are intrinsically linked here,” points out Ellen Kuebrich, Senior Director of Business Development at HealthStream. “The need is to create a dynamic competency program, which means it’s looked at often. This is a really good time to recheck what you've built.” 


Staff input vital to strong competency and assessment programs  


The best way to do that is to engage the entire workforce, she says, noting that “Those frontline staff are going to give you that additional information so that you have a dynamic and effective training competency program. Everyone brings a unique perspective to the table; the more people that you have, the more effective your training and competency program will be.” 


Keep in mind that the competency is going to be a big deal when the surveyors come in, adds  

Patrick Campbell, a master trainer and surveyor, and Senior National Account Services Director with HealthStream.  


“They may stop and talk to your housekeeping staff,” he explains, “They'll also stop and talk to your nursing assistants and your maintenance staff and ask them about how the competencies work. Have these staffers been tested, how does that work? Do they feel like it's a good program? Most of the time that's going to happen after the surveyors have discovered issues, and once they've got something they're concerned about, expect that they're going to talk to all of the staff about how competencies work at your center.” 


In addition to warding off those uncomfortable interview results, getting buy-in from the entire staff will help programs be more robust and lead to better patient care. That’s what CMS is after, rather than being punitive, Campbell says. 


“A lot of times it felt like CMS was just piling on and piling on and piling on and asking us to do these things. But when you start to look at [the regulations] from the sense of how we're going to evolve nursing home care and skilled nursing care, you'll see that these really all do relate and that they are valuable pieces that all influence each other and help each other to be better,” he says. “I think that if we start thinking about considering QAPI, considering facility assessment, in our competency programs, and then working to define those competencies by role, you're going to see a really huge lift in your ability to deliver those competencies.” 


Nursing homes and skilled care facilities that continue to excel are those that treat residents as people worthy of respect, regardless of medical condition or funding source—and regardless of the pressures felt by staff. HealthStream works with skilled nursing and LTC facilities to address these challenges, from keeping pace with regulatory requirements to engaging and developing competent staff who can satisfy the demands of increased patient complexity. By partnering with HealthStream for workforce development solutions, long-term care organizations and others across the care continuum are equipped to seamlessly manage the pressures of surveyor visits, while remaining focused on high-quality patient and resident care. 

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