The proposal includes a net increase of $1.2 billion in Medicare Part A payments, while a relatively large 6.1% market basket update adds $2 billion to address inflationary factors. The rate also reflects a 0.2% productivity adjustment and a $745 million cut intended to offset unintended pay under the Patient Driven Payment Model.

Against expectations, the proposed rule did not include details on a federal staffing mandate, but the agency said they would come “later this spring.”

“It is vital that Medicare reflect the increasing costs — including those imposed by government mandates —nursing homes are facing …,” cautioned Mark Parkinson, president and CEO of the American Health Care Association.

A: Surveillance testing was very effective and we likely underinvested in this. Cheap and fast, but slightly less accurate, on-site antigen tests performed about as well as highly accurate lab-based PCR tests for providing valuable information that helped prevent or slow outbreaks. Facilities that had to wait particularly long for lab-based results did worse than those who got results back more quickly.

Q: So spending about $5 per week per employee for one extra test would have been meaningful? 

A: To the federal government, that’s a drop in the bucket. It could have prevented an estimated 3,079 resident COVID cases and 427 resident deaths per week (in 2020). This translates into a cost of about $13,000 per life saved, an incredibly good value relative to the cost of other life-saving treatment — which could easily range into the millions of dollars per individual — that the Centers for Medicare & Medicaid Services typically covers.

Q:Why didn’t providers use more free tests from the government?

A: I think some of the misinformation and the misunderstanding about the value of the point-of-care testing inhibited our ability to maximize their benefit. [Tests arrived] without a lot of instruction, without a lot of education about how to use them and what they’re good for.

Q: What are some of the implications looking ahead?

A: In the presence of a future infectious disease outbreak or future pandemic, rapid, frequent surveillance testing should be a priority.

The findings emphasize the need for urine sampling and culturing before treating CAUTIs, and the importance of considering therapeutic alternatives, investigators wrote in a study published in Antimicrobial Stewardship & Healthcare Epidemiology.

Data came from approximately 70% of all urine cultures processed in Swiss laboratories in 2019.

The overall resistance rate for the commonly prescribed antibiotics ciprofloxacin, norfloxacin and trimethoprim-sulfamethoxazole was between 13% and 31%. E. coli from CAUTI samples had a higher resistance rate to all antibiotics except for nitrofurantoin. K. pneumoniae and P. mirabilis showed differences only for resistance to quinolones.

In addition, “significantly higher resistance proportions” of certain bacteria were resistant to ciprofloxacin and norfloxacin, investigators reported. 

One standout comparison was P. aeruginosa, which represented 10% of CAUTI pathogens versus only 3.3% of non-CAUTI pathogens.

A: Sometimes residents who have Alzheimer’s or dementia have picking problems, picking at their skin or clothing they may be wearing. 

There are thick elastic arm and leg covers you can purchase to keep those areas covered. Keeping the skin from drying out also will help. 

Document on the care plan whatever you have done — no matter whether it’s worked or not — for a particular resident. That will help new staff understand how to dress the resident, or apply moisturizer to the areas they tend to pick.

If you have someone who does nails in the facility, or someone takes the resident to a nail salon, you can not only have the nails trimmed and filed but there is a powdered application called an SNS nail treatment. Once applied, the nail is thicker and dull with more rounded edges, making picking less possible. The treatment usually stays on and can be reapplied about every three weeks. 

We had SNS applied with a family’s or power of attorney’s permission, and it made a huge difference with skin picking. One family transported their resident to the nail salon, and one of the family members for another resident was a nail technician and would come visit and fix her grandmother’s nails with an SNS treatment.

We care planned everything and their skin looked great within a few months after applying the nail treatment.

Start with baby steps and get the family and/or POA involved if the resident can’t make decisions on their own. Sometimes, traditional arm covers or moisturizer will be your answer.

As we know, every resident responds differently to different approaches.

Please send your resident care-related questions to Sherrie Dornberger at ltcnews@mcknights.com.

A: It is important to know what outcome to expect when a patient with a wound is being discharged from a rehabilitation facility. Will the wound heal or maintain its status quo or is it non-healing? As many efforts are made to heal any wound, one needs to know the key factors that will guide care.

The first priority is to assess the healing ability of the wound. Factors that foster wound healing include a correctable cause and adequate blood supply. Non-healing wounds, on the other hand, do not have a correctable cause or adequate blood supply. 

Wounds often persist though they may have the capability to heal. Both patient-related factors and healthcare factors can impair healing. Administrators, nurses and others should understand whether a patient can help care for himself or herself and how the patient perceives the wound. 

Also, ask if the patient is able to access and afford necessary wound care products. Does the patient or a caregiver know how to care for wound care equipment? Often, these inquiries are made but missed at discharge, resulting in wound deterioration, infections and recurrent hospitalization. Person-centered care may take extra time but can lead to much better outcomes. 

Documentation of these assessments are an important part of resident care. Litigation and liability risks amplify if such care is not documented. The documentation of initial assessment, daily monitoring and weekly assessment is the minimal expectation by the Centers for Medicare & Medicaid Services. Excellent patient care and timely documentation saves the residents and the facilities from unwarranted frustrations and litigation. After all, what is not documented is not done!

Please send your wound care-related questions to Fatima Naqvi at ltcnews@mcknights.com.

Omega-3-rich fish skin grafts are derived from North Atlantic cod in a process that preserves a chemical composition that closely resembles human skin. Scientists have shown they promote efficient growth of skin cells and capillaries and have anti-inflammatory properties.

In this study, clinicians from eight US hospital systems and wound clinics sought to better understand whether fish skin grafts led to more wound closures than the clinically accepted practice of applying collagen alginate therapy to nonresponsive diabetic foot ulcers. They also conducted a cost analysis to highlight immediate and long-term economic advantages of using fish skin.

Just under 57% of the DFUs treated with fish skin achieved closure versus about 31% of those treated with collagen, and there was an annual cost savings of $2,818 compared to collagen treatment.

The full study, which highlighted higher cost savings when factoring in non-healed wounds, was published in the April issue of Wounds.

The bandage (pictured) is made from a flexible polymer embedded with electronics and medication developed by medical engineers and may offer a less expensive alternative to traditional wound care regimens.

Sensors can monitor for uric acid or lactate and conditions like pH level or temperature that typically indicate inflammation or infection, Caltech researchers explained in the March 24 issue of Science Advances.

The bandage then can respond by wirelessly transmitting data for review by a medical professional; deliver an appropriate antibiotic or other medication directly to the wound site; and apply low-level electrical stimulation to promote new tissue growth.

“We have showed [sic] this proof of concept in small animal models, but down the road, we would like to increase the stability of the device but also to test it on larger chronic wounds because the wound parameters and microenvironment may vary from site to site,” said Wei Gao, an assistant professor of medical engineering who led the NIH-funded project. 

Researchers compared data on the numbers of antibiotic prescriptions for suspected urinary tract infections among 1,041 older adults at 38 senior care homes in the Netherlands, Norway, Poland and Sweden.

The intervention group included facilities in an antibiotic stewardship training program where doctors, nurses and nurse assistants received instruction and participated in discussions on optimal care for suspected UTIs. The program included a decision tool for appropriate antibiotic use.

Those who followed the program cut in half the number of UTI antibiotic treatments compared with a control group. There were no differences in complications, hospitalizations or deaths ensuing from UTIs.

“The effectivity across diverse settings in our study makes it plausible that tailored implementation in other countries would be effective as well,” the researchers wrote. 

They said more work is needed for UTI prevention, improved choice and duration of antibiotics, and reduced unnecessary use.

A: When transitioning care, the first step is ensuring the next provider can adequately care for the patient. Make sure any home health partner can see the patient soon after discharge, preferably within 24 to 48 hours. 

Home health agencies also must have enough information and resources to meet the patient’s needs. You’ll need to verify equipment, medications, treatments and follow-up appointments. 

Durable medical equipment. Ensure equipment is ordered and has been or will be delivered. This includes items like wheelchairs or beds, but it may also include medical devices for treatment. 

Medications. Upon discharge, ensure  home health receives the medication reconciliation. Additionally, ensure patients can get their medications, noting any finance or transportation issues. Address this prior to discharge and express any concerns to the agency. 

Treatments. Ensure supplies have been ordered and delivered. Wound supplies, nebulizer supplies, CPAP/BiPAP supplies, blood glucose monitoring supplies and more may be necessary in the home. 

Follow-up appointments. When possible, schedule and alert home health to any follow-up appointments. Making the appointments for the patient improves chance of attendance. Ensure the patient has transportation or arrange it. 

Finally, call the patient and/or caregiver within 48 hours to ensure home health has seen them. Confirm the patient has received all the above items and answer follow-up questions. Easing the transition can assure needed care continues even after the patient leaves your facility.  

In a review, investigators at the University of Texas Health Science Center at Houston sought to determine whether technology could help address care disparities among patients who have had a stroke, and in which ways it might widen care barriers.

They highlighted the benefits of using telerehab for a range of stroke impairments, including problems with gait, vision and cognition, as well as in addressing issues of economic instability and location.

The researchers noted, for example, that for patients dealing with stroke-related disabilities, telehealth addresses barriers related to mobility challenges and special equipment needed to access clinic spaces by removing the need for transportation altogether. It also decreases the number of in-person visits required of patients, allowing for better multidisciplinary care and the ability to remotely monitor blood pressure and
cardiac arrhythmias.

The team also identified barriers to telehealth, including physical and cognitive disability from stroke, and limited internet access, digital literacy and
English proficiency.

They outlined potential solutions, including social workers who can connect patients to federal programs offering discounts for internet access and technology purchases; provision of mobile hotspot devices to patients with limited Wi-Fi access; use of cellular devices for telemonitoring rather than services requiring Bluetooth; and use of texting, secure messaging smartphone apps, and other tools that do not require high-speed internet. The full review was published in the journal Stroke.