Long-Term Care: Are Your Residents at Risk?
Resident safety and welfare in long-term care (LTC) is being redefined as the focus shifts to promoting an optimal quality of life. Achieving this requires applying knowledge of best practices for identifying, communicating, documenting, and managing the risks that arise from the choices made in the pursuit of a better quality of life. Proactive risk management requires identifying the hazards associated with a resident’s choices and implementing interventions to enhance their quality of life.
The first step in preventing adverse events during a residency in a long-term care facility includes determining risk, whether it is a risk for falls, infections, nutritional deficits, pressure injuries, or any adverse event. Upon completion of risk assessments, the risk factors identified should guide you in developing a care plan. Preventative measures should be implemented, and the effectiveness of those interventions should be evaluated based on the individual resident’s risk factors and goals.
Falls are the leading cause of death in adults aged 65 or older. Regulations set forth by the Centers for Medicare and Medicaid Services (CMS) include F-Tag 689 regarding accidents. This regulation includes assessing the individual resident’s risk for an accident. Generally, this can be accomplished using a fall risk assessment which should be performed on admission and at least quarterly after that. Multiple fall risk assessment tools are available for use and can provide the needed risk determination. These may include but are not limited to the Morse Falls Scale, the Briggs Healthcare Fall Risk Assessment, and the Hendrich II Fall Risk Model. An accurate assessment of a resident’s risk for falls and accidents will ensure compliance with CMS regulations and initiate the pathway for fall/accident prevention.
The current standard of care in pressure injury prevention is based on risk assessment and visual assessment of skin in areas prone to pressure injuries. Per the Centers for CMS F-Tag F686 for the prevention of pressure injuries, the facility must first identify whether the resident is at risk for developing or has a pressure injury upon admission. To prevent a resident from developing a pressure injury, their risk factors should be determined via the comprehensive resident assessment. A formal risk assessment tool is an excellent way to identify some – but not all – risk factors. Such tools can include a Braden Scale and the Norton Plus Pressure Ulcer Scale. Current recommendations indicate that the assessments should be performed on initial admission, weekly for four weeks, and quarterly after that and as needed. Assessments should also be performed on re-admission to the facility following a stay in the hospital or an outside facility.
Dehydration is common in the elderly and a frequent cause of hospital admission. CMS Regulation F-Tag F692 regarding assisted nutrition and hydration includes recognizing the needs of every resident concerning their risk for impaired nutrition and hydration. Again, an initial accurate assessment of a newly admitted resident’s risk for these impairments is paramount to ensure these issues are avoided if possible. A malnutrition risk assessment can be beneficial in determining this risk.
The importance of accurately determining those residents at risk for adverse events cannot be overstated. The Med Law Advisory Partners team are experts in regulations affecting long-term care facilities and providing guidance if or when adverse events occur. Contact us today to add our expertise to your arsenal.