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Part III Standards for Compliance

and caregivers compare nursing homes more easily and to help identify areas about which they might want to ask questions (13). The Nursing Home Compare website features a quality rating system that provides each nursing home a rating of between one and five stars. Nursing homes with five stars are considered to have above-average quality and nursing homes with one star are considered to have below-average quality. More than 12 million assess- ments of the conditions of nursing home residents are used in the Five-Star Quality Rating System. There is one overall five-star rating for each nursing home and a separate rating for each of the fol- lowing three sources of information:

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Health inspections: The health inspection rating contains information from the last three years of on-site inspections, including both standard surveys and any complaint surveys. This informa- tion is gathered by the surveyors to determine the extent to which a nursing home has met Medicare’s minimum quality requirements. The most recent survey findings are weighted more than the prior two years.

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Staffing: The staffing rating has information about the number of hours of care on average provided to each resident each day by nursing staff. This rating considers differences in the level of need of care of residents in different nursing homes. For example, a nursing home with residents who had more severe needs would be expected to have more nursing staff than a nursing home where the resident needs were not as high.

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Quality measures (QMs): The quality measure rating has information on 11 different physical and clinical measures for nursing home residents—for example, the prevalence of pressure sores and significant weight changes. This information is collected by the nursing facility for all residents. The QMs offer informa- tion about how well nursing homes are caring for their residents’ physical and clinical needs.

As with all rating systems, no single system can address every important consideration that goes into deciding which nursing home may be best for a partic- ular person. Consumers should therefore use this infor- mation, together with other sources of information for the nursing home (eg, visits to the nursing home, local advocacy groups, state ombudsman program), when making a decision on placement.

The RDN and NDTR can play an important part in helping the facility maintain a high star rating by pro- viding sound assessments and implementing

interventions that can prevent weight changes, main- tain skin integrity, and improve overall quality of care for residents.

SUMMARY As the acuity and complexity of residents have increased over the years, so have the assessment and survey pro- cesses. The MDS RAI Manual, with its six-month revi- sions and YouTube videos for guidance, is a good indicator of how information changes on a routine basis and how critical it is for the RDN to stay on top of these changes. The basis of the IDT’s work is to make sure the resident has the highest quality of life possible; this is driven by the individualized resident assessment and the use of critical thinking skills and professional standards in the development and revision of each resident’s care plan. The survey mirrors this process in the use of inter- views, observations, and record reviews to verify that assessments are correct and revised when necessary, and the plan of care is resident-driven and accurately reflects the resident’s status. The RDN must pay close attention to regulatory revisions and to the MDS process while focusing on the resident to ensure quality resident care and positive survey results.

REFERENCES 1. Centers for Medicare & Medicaid Services. MDS 3.0 RAI Manual v1.13. www.cms.gov/Medicare/ Quality-Initiatives-Patient-Assessment-Instruments/ NursingHomeQualityInits/MDS30RAIManual.html. Accessed October 14, 2015.

2. Centers for Medicare & Medicaid Services. State Oper- ations Manual. www.cms.gov/Regulations-and-Guid- ance/Guidance/Manuals/

Internet-Only-Manuals-IOMs-Items/CMS1201984. html. Accessed October 14, 2015.

3. Centers for Medicare & Medicaid Services. State Oper- ations Manual, Appendix PP. http://cms.hhs.gov/manu- als/Downloads/som107ap_pp_guidelines_ltcf.pdf. Accessed October 14, 2015.

4. Centers for Medicare & Medicaid Services. State Oper- ations Manual, Appendix Q. http://cms.hhs.gov/manu- als/Downloads/som107ap_q_immedjeopardy.pdf. Accessed October 14, 2015.

5. Centers for Medicare & Medicaid Services. State Oper- ations Manual, Appendix P. http://cms.hhs.gov/manu- als/Downloads/som107ap_p_ltcf.pdf. Accessed October 14, 2015.

6. Centers for Medicare & Medicaid Services. Procedures for conducting federal oversight of Quality Indicator Survey (FOQIS). www.cms.gov/Medicare/Provider- Enrollment-and-Certification/SurveyCertificationGen- Info/QIS-Comparative-FOQIS.html. Accessed October 14, 2015.

7. Centers for Medicare & Medicaid Services. CMSHHSGov. www.youtube.com/user/CMSHHSgov. Accessed October 14, 2015.