In this LTC NAC Chat podcast episode, Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, chief nursing officer for AAPACN, and Jessie McGill, RN, BSN, RAC-MT, RAC-MTA, senior curriculum development specialist for AAPACN, discuss the Five-Star management challenges nurse assessment coordinators are facing today. Additional Resource: GG Trivia Games LTC NAC Chat – Five-Star Management Challenges NACS Are Facing - Full Transcript(intro music) Amy: Hello, thank you for joining LTC NAC Chat, a podcast brought to you by the American Association of Post-Acute Care Nursing (AAPACN). I'm your host, Amy Stewart, Chief Nursing Officer for AAPACN, and I'm here today with Jessie McGill, Senior Curriculum Development Specialist for AAPACN. Jessie joins us to discuss the Five-Star management challenges nurse assessment coordinators are facing today. Welcome, Jessie! Jessie: Thanks for having me today, Amy. Amy: Jessie, let's dive right in. In a recent survey in the AAPACN Leader for the NAC newsletter, members describe difficulty understanding how the different parts of Five-Star work together. What makes this system so challenging for NACs to interpret and manage? Jessie: That's a great question. One of the biggest challenges of Five-Star is that we have a lot of different data coming from different areas and using different time frames. So we have the health inspection domain, which uses the two most recent standard surveys, so it's looking at your health inspections, and 36 months of infection control and complaint surveys. So, we already have a couple different time frames just with health inspections and a couple different data points that are impacting your health inspection. For the staffing domain, this looks at the hours that the facility self-reports in the Payroll-Based Journal, and it looks at 12 months of data and it's updated quarterly. The quality measure domain is also updated quarterly and uses four full quarters of data but with a delay. And the quality measure domain pulls from different quality measures that are both MDS-based as well as a few claims-based measures. So, a couple different data points with quality measures also. For the NAC, one of the ways to look at Five-Star and hopefully make it a little less challenging is to understand that they're not the sole responsible person for managing all aspects of Five-Star. They may be highly involved with the understanding and reporting when it comes to the QM domain because most of the quality measures used for that domain are MDS-based. But that should be more to understand the underlying data and then working with your entire team to understand how the domains work together for your overall Five-Star rating. Amy: Thank you for that. Another challenge noted by the survey respondents was documentation, especially for section GG. How can NACs overcome documentation challenges and ensure accuracy when coding the MDS?" Jessie: Oh, GG always gives us so many challenges. When we look at section GG, we have essentially two different processes that are going on. The first is the underlying documentation. This is what's actually happening during those three-day windows for each of those episodes of care, whether it's with the CNAs, the nurse, or the therapy team. And then you have the second part, which is the review of all of that documentation during the three-day window to determine the resident's usual performance. And so we have to have two strong processes in place. First is a strong process for that underlying documentation. And the second is a strong process to determine usual performance. The underlying documentation requires that we have really consistent and ongoing education with the staff members who are going to be documenting or charting those GG tasks, such as: How did the resident eat? How did they transfer? How did they move from sitting to lying? How did they transfer into the bath? So for all of those different GG tasks, the direct care staff needs to understand the RAI User's Manual definition—what is included as well as what is not included? And also understanding the performance levels. So what is partial-moderate assist, what is substantial-max assist, as well as supervision or setup help only? So there's a lot that goes into those performance levels as well as the different tasks. Now, one of the cool things that AAPACN has is a GG Trivia Game, which we actually have two versions now. And the GG Trivia Game is an education tool, it’s free for members, that you can use with your direct care staff to help reinforce in a game fashion different GG tasks in the different performance levels. So, creating education that's fun is a great way to reinforce your other training. Another thing that we need to do with that direct care staff is we have to validate that what is being charted is accurate. So, that may include different types of audits or validation processes. One of my favorite ways to validate if the charting is ...
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