BEHAVIOR TAGS FOR NURSING HOMES PREPARED BY Stormy

BEHAVIOR TAGS FOR NURSING HOMES PREPARED BY… Stormy Smith, B. S. , LNH, CPM, SMQT CERTIFIED 1

BEHAVORIAL HEALTH SERVICES (F-740 TO F-745 IMPLEMENTATON NOVEMBER 2018. Ø Ø Ø Ø F-740: BEHAVIORAL HEALTH SERVICES. F-741: SUFFICIENT/COMPETENT STAF-BEHAV HEALTH NEEDS. F-742: TREATMENT/SVS FOR MENTAL/PSHCHOSOCIAL CONCERNS. F-743: NO PATTERN OF BEHAVIORAL DIFFICULTIES UNLESS UNAVOIDABLE. F-744: TREATMENT/SERVOCES FOR DEMENTIA. F-745: PROVISION OF MEDICALLY RELATED SOCIAL SERVICES. F-742 THROUGH F-745 IS SUBSTANDARD QUALITY OF CARE FOR ANY SCOPE AND SEVERITY LEVEL AT F, H, I, J, K, OR L. 2

BEHAVORIAL HEALTH SERVICES F-740 (483. 40) Ø Each resident must receive and the facility must provide the necessary behavioral health care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and plan of care. 3

BEHAVORIAL HEALTH SERVICES F-740 (483. 40)Cont’d. Ø Behavioral health encompasses a resident’s whole emotional and mental well-being, which includes, but not limited to the prevention and treatment of mental and substance disorders. 4

BEHAVORIAL HEALTH SERVICES F-740 (483. 40) DEFICIENCY CATERGORIZATION Ø AN EXAMPLE OF SEVERITY LEVEL 4 NONCOMPLIANCE: IMMEDIATE JEOPARDY TO RESIDENT HEALTH OR SAFETY: Ø The facility failed to investigate underlying causes of the resident’s anxiety and agitation and failed to develop and implement individualized interventions for the resident which led to numerous elopement episodes and injury 5

SUFFICIENT/COMPETENT STAFF-BEHAV HEALTH NEEDS F-741 (483. 40(a) Ø The facility must have sufficient staff who provide direct services to residents with appropriate competencies and skills sets to provide nursing and related services to assure resident safety and attain or maintain the highest practicable physical, mental and psychosocial well-being of each resident, as determined by resident assessment and individual plans of care and considering the number, acuity and diagnoses of the facility’s resident population in accordance with 483. 70(c). These competencies an skills sets include, but are not limited to, knowledge and appropriate training and supervision. 6

SUFFICIENT/COMPETENT STAFF-BEHAV HEALTH NEEDS F-741 (483. 40(a)(1) IMPLEMENTATION PHASE 3 NOV. 28, 2019 Ø Caring for residents with mental and psychosocial disorders, as well as residents with a history of trauma and/or post-traumatic stress disorder, that have been identified in the facility assessment conducted pursuant to 483. 70(e), and as linked to history of trauma and/or post-traumatic stress disorder, will be implemented beginning November 28, 2019 (Phase 3). 7

SUFFICIENT/COMPETENT STAFF-BEHAV HEALTH NEEDS F-741 (483. 40(a) AND 483. 40 (a)(2) AN EXAMPLE OF SEVERITY LEVEL 4 NONCOMPLIANCE: IMMEDIATE JEOPARDY TO RESIDENT HEALTH OR SAFETY: The facility lacked sufficient staff with the required skills sets to implement the resident’s care planned interventions. This led to increased expressions of distress and a threat of personal harm resulting in the deterioration of the resident’s mental and psychosocial well-being. 483. 40(a)(2) IMPLEMENTING NON-PHARMACOLOGICAL INTERVENTNIONS. 8

TREATMENTSVC FOR MENTAL/PSYCHOSOCIAL CONCERNS F-742 (483. 40(b) & 483. 40(b)(1) Ø 843. 40(b) Based on the comprehensive assessment of a resident, the facility must ensure that… Ø 483. 40(b)(1) A resident who displays or is diagnosed with mental disorder or psychosocial adjustment difficulty, or who has a history of trauma and/or posttraumatic stress disorder, receives appropriate treatment and services to correct the assessed problem or to attain the highest practicable mental and psychosocial well-being. 9

TREATMENTSVC FOR MENTAL/PSYCHOSOCIAL CONCERNS F-742 (483. 40(b) & 483. 40(b)(1) Ø AN EXAMPLE OF SEVERITY LEVEL 4 NONCOMPLIANCE: IMMEDIATE JEOPARDY TO RESIDENT HEALTH OR SAFETY: Ø The facility failed to acknowledge and assess the underlying causes of the resident’s expressions of distress or develop and implement a care plan that addressed this distress. This resulted in the deterioration of the resident’s physical, mental and psychosocial wellbeing. 10

NO PATTERN OF BEHAVIORAL DIFFICULTIES UNLESS UNAVOIDABLE F-743 (483. 40(b)(1) Ø A resident whose assessment did not reveal or who does not have a diagnosis of a mental or psychosocial adjustment difficulty or a documented history of trauma and/or posttraumatic stress disorder does not display a pattern of decreased social interaction and/or increased withdrawn, angry or depressive behaviors, unless the resident’s clinical condition demonstrates that development of such a pattern was unavoidable. 11

NO PATTERN OF BEHAVIORAL DIFFICULTIES UNLESS UNAVOIDABLE F-743 (483. 40(b)(1) Ø AN EXAMPLE OF SEVERITY LEVEL 4 NONCOMPLIANCE: IMMEDIATE JEOPARDY TO RESIDENT HEALTH OR SAFETY: Ø The facility’s failure to identify that the resident was in distress and needed a mental health assessment caused a delay in receiving appropriate services and deterioration in the resident’s psychosocial well-being. 12

TREATMENT/SERVICE FOR DEMENTIA F -744 (483. 40(b)(3) Ø A resident who displays or is diagnosed with dementia, receives the appropriate treatment and services to attain or maintain his or her highest practicable physical, mental and psychosocial well-being. 13

TREATMENT/SERVICE FOR DEMENTIA F -744 (483. 40(b)(3) Ø AN EXAMPLE OF SEVERITY LEVEL 4 NONCOMPLIANCE: IMMEDIATE JEOPARDY TO RESIDENT HEALTH OR SAFETY. Ø The facility failed to implement individualized interventions as well as revise the care plan accordingly, to address the resident’s dementia care needs, resulting n injury as evidenced by observation, record review and/or interview. 14

PROVISION OF MEDICALLY RELATED SOCIAL SERVICES F-745 (483. 40(d) Ø The facility must provide medically-related social services to attain or maintain the highest practicable physical, mental and psychosocial well-being of each resident. 15

BEHAVIORAL HEALTH TRANING F-949 § 483. 95(i) Behavioral health. A facility must provide behavioral health training consistent with the requirements at § 483. 40 and as determined by the facility assessment at § 483. 70(e). [§ 483. 95(i) will be implemented beginning November 28, 2019 (Phase 3) 16

§ 483. 21(b)(3) Comprehensive Care Plans (F -659) Ø § 483. 21(b)(3) Comprehensive Care Plans The services provided or arranged by the facility, as outlined by the comprehensive care plan, must— (ii) Be provided by qualified persons in accordance with each resident's written plan of care. (iii) Be culturally-competent and trauma–informed. Ø Ø [§ 483. 21(b)(iii) will be implemented beginning November 28, 2019 (Phase 3)] 17

https: //www. cms. gov/Medicare/Provider-Enrollment-and. Certification/Guidancefor. Laws. And. Regulations/Nursing-Homes. html Ø Downloads • • • • Revision History for LTC Survey Process Documents and Files - Updated 12/12/2018 [PDF, 132 KB] LTC Survey FAQs - Updated 08/03/2018 [PDF, 525 KB] Appendix PP State Operations Manual (Revised 11/22/2017) [PDF, 3 MB] List of Revised FTags [Effective November 28, 2017] [PDF, 152 KB] F-Tag Crosswalk [XLSX, 495 KB] New Long-term Care Survey Process – Slide Deck and Speaker Notes [PPTX, 8 MB] LTC Survey Pathways - Updated 08/03/2018 [ZIP, 5 MB] LTCSP Procedure Guide - Updated 08/03/2018 [PDF, 877 KB] LTCSP Initial Pool Care Areas - Updated 12/12/2018 [ZIP, 1 MB] Survey Resources - Updated 12/12/2018 [ZIP, 14 MB] CMS-802 - Updated 12/12/2018 [PDF, 178 KB] LTCSP Interim Revisit Instructions - Updated 08/03/2018 [PDF, 71 KB] Initial Surveys [ZIP, 734 KB] 18