Issue: November 13, 2013

Published on November 13, 2013

Articles in this issue:

The Validation Method: A KHCA/KCAL Education Opportunity by Naomi Feil, MS

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KHCA/KCAL is proud to present Naomi Feil, MS.  She will be presenting on her famous Validation Therapy method, in Wellsville, Kansas on December 10, 2013.

What is Validation Therapy? Validation is a tested model of practice that helps older adults who experience disorientation and memory loss to reduce stress and enhance dignity and happiness. Validation accepts the older adult who mentally returns to the past. Often, his/her retreat is not a form of mental illness or disease, it is a survival technique. They return to the past to relive the good times and resolve the bad times in this final struggle to find peace.

Purpose of Validation Workshop: This workshop is designed for health and human service workers, families and volunteers who wish to learn how to communicate with older adults who experience disorientation and memory loss. Its overall objectives are to restore dignity to the older adult, to teach empathy, to increase self-awareness of one’s own aging and to apply Validation Techniques.

About the Presenter: Naomi Feil, M.S., A.C.S.W, is the developer of Validation. She was born in Munich in 1932, and grew up in the Montefiore Home for the Aged in Cleveland, Ohio, where her father was the administrator and her mother, head of the Social Service Department. After graduating with a Masters degree in Social Work from Columbia University in New York, she began working with the elderly. Between 1963 and 1980 Mrs. Feil developed Validation as a response to her dissatisfaction with traditional methods of working with older adults who experience severe disorientation. In 1982 she published her first book, Validation: The Feil Method, which was revised in 1992. Her second book, The Validation Breakthrough, was published in 1993, and updated and revised in 2002. Mrs. Feil and her husband have made many films and videos about aging and Validation. Mrs. Feil is the Executive Director of the Validation Training Institute and a popular speaker in North America and Europe.

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MDS Corner with Judy Bagby, BSN

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In this week's episode of MDS Corner with Judy Bagby, BSN: Section G- Coding ADLs

  October 1, 2013 CMS posted clarification on MDS key coding items.  This week we’ll discuss how to code ADLs for section G0110.   The information being keyed in this section influences the RUG level for PPS, Managed Care, Case Mix rates and PEPPER Reports.  In the review process by payment sources this item set affects reimbursement recoupments.

   The clarification from CMS pertains to the use of the ADL Self Performance Alogrithm found on page G-6 of the RAI Manual.  The clarification that was posted did not change how the resident ADLs were to be scored, but was a reminder of the “Rule of 3” that has been in place since the initial use of MDS 3.0.  On the MDS the look back period is 7 days.  Self -Performance measures what the resident actually did with each ADL for G0110.  The ADL question identifies the most support that staff provided over the 7 day observation period.  The staff should provide information each shift over the 7 day observation period to support the coding on the MDS and identify inconsistencies with resident needs.

   What is the Rule of 3?  This is when an ADL Self Performance activity occurs 3 or more times at any one given level.  The coder keys that level for self- performance.   But what happens when the activity occurs at more than one level?  This requires assessment to rule out incorrect staff reporting and also to identify unexplained variations in reporting resident abilities, or staff “not letting the resident perform when able.”  With the Rule of 3 “if an activity occurs 3 times at multiple levels the coder uses the most dependent area.  Exceptions are total dependence (4)-activity must require full assistance every time; and activity did not occur (8)- activity must not have occurred at all.  Example: three times extensive assist (3) and three times limited assist (2)- code extensive assist (3).”  When an activity occurs at “more than one level but not three times at any one level” follow the ADL Self Performance Alogrithm and remember if none of the Rule of 3 conditions are met you code as Supervision.   Getting staff in- put multiple times on all shifts during the 7 day observation will help to ensure correct coding,

  The RACs, MACs, Managed Care and now PEPPER are focused on the importance of the RUG level being determined by how ADL Self Performance was coded on an MDS.  Education of staff must be ongoing for accuracy in this area as it relates to payment and a cross reference to resident performance with resource needs.  The goal continues to be focused on services being provided to assist the resident with maintaining their highest level of functioning.

CMS Update- SC14-01 Caridopulmonary Resuscitation in Nursing Homes

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CMS Update on CPR in the Nursing Center:

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Relias Learning Message on Alzheimers

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An announcement from Relias Learning regarding new online training to address Alzheimer's and dementia need:

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OSHA's Revised Hazard Communication Standard

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OSHA has revised its Hazard Communication Standard to align with the United Nations Globally Harmonized System of Classification and Labeling of Chemicals.  All nursing centers and assisted living centers must train staff on this new standard by December 1, 2013.

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