For Skilled Nursing Facility Administrators/Directors
How does Psych360 approach psychiatric services provided in skilled nursing facilities?
Psych360 stands out because we are committed to long-term care 100% of the time. Our team has home-office support to answer in-field questions and are on-call 24/7 for you. We schedule regular visits in advance, and we visit all residents on psychotropics to evaluate needs, perform GDRs, and consistently build approved documentation. Your staff will receive a list with report sheets prior to all visits that encourage up-to-date feedback. This also allows additional residents to be included as well as informational updates prior to each visit. Every appointment is followed by an EMR report.
We believe a resident’s quality of life is always improved if they are treated in familiar surroundings. That’s why we work hard to maintain clear communications on all medication adjustments, side effects, and situational changes between, staff, physicians & families. Our communication is excellent.
The Psych360 Team benefits your facility by applying proven and knowledgeable programs to monitor, assess and treat every aspect of a resident’s mental health care in a skilled nursing home environment. Our protocols result in quality outcomes through improved communications, state compliance, GDRs, thorough documentation, and by implementing knowledge and expertise within the state and CMS rules and regulations.
How does Psych360s approach provide better resident psychiatric care and make your life easier?
By adhering to a “total spectrum” interdisciplinary approach the Psych360 Team can fully appreciate and educate all key groups, and provide recommendations that can improve a residents’ quality of life, often before a crisis or hospitalization is required.
When you contract with us, we completely manage the psychiatric aspect. We achieve our goals by managing all medications—including gradual dose reductions (GDRs)— and then, by clearly communicating to all other related data-dependent channels, i.e. non-pharm, pharm management/optimization, improved quality of life, decreased polypharmacy, decreased depression, decreased falls, decreased unnecessary med use, decreased hospitalization and more. Thereby, keeping you compliant with state and CMS guidelines and regulations, which impact your 5-star rating for short-term and long-term stays relative to antipsychotics, anti-anxiety/hypnotics, depression, behavioral health, and falls.
How are skilled nursing facilities regulated for mental health services?
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. Behavioral health encompasses a resident’s whole emotional and mental well-being.
The following information is important for staff to be familiar with:
- Prevention and treatment of mental and substance use disorders.
- The drug regimen of each resident must be reviewed at least once a month by a licensed pharmacist.
- The pharmacist must report any irregularities and they must be acted upon immediately.
Regarding psychotropic drugs:
- Any drug that affects brain activity associated with behavior and mental processes.
- Reduce or eliminate the use of psychotropic drugs if not clinically contraindicated.
- Drug regimen must be free from unnecessary drugs.
- Recognizes that hospitals and community centers start antipsychotics.
- The responsibility of nursing homes to evaluate.
- The evaluation must be documented in the clinical record on admission or within 14 days after admission.
Key coding numbers & definitions to remember:
F-tag is a code of deficiencies that facilities are cited on.
There are three codes that are directly related to behavioral health and a 5-Star rating: F329, F222, and F309.
F329 looks to ensure the resident receiving a psychotropic has the appropriate dx and dosing, are being monitored, are providing rationale in the documentation for continued use, and if they cannot provide that, they are performing gradual dose reductions (GDRs).
Prior to prescribing psychotropics for BPSD, the following information must be noted:
- Address for underlying medical, physical, functional, psychosocial, emotional, psychiatric, or environmental cause of the behaviors.
F329 tracks unnecessary medication use by:
- Documenting an acceptable clinical indication for use.
- Demonstrating monitoring for each mediation as appropriate.
- Demonstrating appropriate dosing of each medication.
- Documenting clinical rationale for continued use of the medication(s) as appropriate.
- Demonstrating a system for and documents considerations for GDR as appropriate.
F222 states that the resident has the right to be free from any physical or chemical restraints imposed for purposes of discipline or convenience and not required to treat a resident’s medical symptoms.
F309 Quality of Care
Each resident must receive and the facility must provide the necessary care and services to maintain the highest practicable physical, mental, and psychosocial well-being in accordance with the comprehensive assessment and plan of care:
- Behavioral interventions.
- Person-centered or person-appropriate care.
- Behavioral or psychological symptoms of dementia.
How does Psych360 help your skilled nursing facility (SNF) pass a state survey?
The Psych360 Team applies established protocols when interacting with your facility that keep your center compliant. Our data collection systems are compliant with all state, CMS, and federal regulations, and not only allow facilities to pass, but consistently improve their standing toward reaching and maintaining 5-Star status. We are familiar with the quality measures that impact citations including psychotropics, antipsychotics, anti-anxiety/hypnotics, depression symptoms, behaviors health, and falls.
We provide proper and timely documentation to assure that GDRs (gradual dose reductions) are reviewed. We make certain GDRs are either administered or that documentation or a diagnosis to support to continue use and follow up is provided. We assess for side effects including tardive dyskinesia in addition to evaluating if a patient can tolerate a lower dose or if a safer more effective medication can be used. And when a survey is in process, we are available to answer or clarify any questions or concerns state surveyors may have.
In addition, we monitor CASPer and psychotropic reports quarterly, and provide state-required dementia training if needed.
In a word, SUPPORT. Total Support is what we provide for you.
For Families and Other Interested Parties
What is a skilled nursing facility? How is it different than other long-term care facilities?
Generally speaking, long-term care describes a nursing home facility, which is more of a medical model. A skilled nursing facility is licensed and has the ability to offer nursing or rehabilitation services such as IV therapy, occupational, in addition to speech and physical therapies. Typically, patients will be discharged from a hospital stay and, if still requiring care, will go for a skilled nursing facility (SNF) to recover and receive rehabilitation before returning home. An assisted living facility is not considered long-term care, and is more like a home environment with á la carte services.
Does Medicare cover a residents stay in a skilled nursing facility?
Are psychiatric services required to be offered in a SNF?
A SNF must meet the needs of a resident regardless of what that means. Per CMS, 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. Behavioral health encompasses a resident’s whole emotional and mental well-being.
Why is psychiatric care for skilled nursing facility residents important?
Psychiatric services need to be present to foster the best quality of life possible in order to provide the best possible state of mental health, encourage healthy social interaction, and promote general well-being. These are fundamental to a resident’s feeling of happiness and self-satisfaction.