Unparalleled Changes in Skilled Nursing Regulations

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“For the past 30 years, regulations didn’t change in long-term care, but now we are in a whirlwind of change.” – Mike Carson, COO of Grace Healthcare

Can you talk a little about current regulations? How have these changes in regulations impacted your organization?
“Centers for Medicare & Medicaid Services (CMS) has updated the entire guidelines for regulations in long-term care. As you probably know, we are currently in phase 2 of the Mega Rule, and it’s revamping everything. For the past 30 years, regulations didn’t change, but now we are in a whirlwind of change.
CMS has implemented a hybrid survey of the Quality Indicator Survey (QIS) and the standard process. This is the process that surveyors are applying, and it’s going to hit the homes in 2018.
In addition, the process of coding F-tags has completely changed. We are working with a dual system, but in November 2019 (phase 3), we will move totally to the new tags.
Surveyors are crosswalking us for deficiencies based on these dual systems. We have 32 locations, and we have had a few locations audited since the phase 2 start. We’ve seen a huge jump in the number of deficiencies from those audits. While this won’t impact 5-star ratings due to the freeze on 5-star ratings, the regulatory changes will increase deficiencies.”

Do you think the impact is the same at the facility level?
“I think these regulation changes are going to put a much stronger emphasis on care planning, resident assessments, general education, and case management based on resident condition.”

How can you satisfy your regulation needs and maintain a smoothly operating facility?
“I think having efficient, competent partners is more important than ever. We will need to lean on our electronic health record and other key partners to help us manage these day-to-day challenges.”

What do you think will be the greatest opportunities and challenges in long-term care in 2018?
“I think census and staffing are the biggest opportunities and challenges. The average occupancy is dropping. I have been a nurse for 31 years, and I’m seeing the same patients in nursing homes that we saw 20-25 years ago in a hospital setting.
The census problems are compounded by the fact that there are fewer students choosing nursing. Unfortunately, fewer nurses in nursing programs eventually leads to a nursing shortage.”

Mike Carson

Mike Carson is the Chief Operating Officer at Grace Healthcare. He is tasked to manage 32 buildings spanning 7 states. Mike has been an RN for 31 years and began his career as an ICU nurse. He has years of experience that stretch from nurse to administrator to Director of Clinical Services and now COO. Click here to read more about Grace Healthcare.