| December 2024 Newsletter The Center of Excellence for Behavioral Health in Nursing Facilities (COE-NF) provides mental health and substance use evidence-based training, customized technical assistance, and resources to certified Medicare and Medicaid nursing facilities that care for residents with a variety of behavioral health conditions at absolutely no cost. To submit a request for
assistance, complete the online request form by clicking HERE. | | |
On November 18, 2024, Centers for Medicare and Medicaid Services (CMS) issued
Memorandum Ref: QSO 25-07-NH outlining revised surveyor guidance that affects several areas including, but not limited to: - Admission, Transfer & Discharge
- Chemical Restraints/Unnecessary Psychotropic Medication
- Resident Assessment
- Quality of Life and Quality of Care
- Administration
- Quality Assurance Performance Improvement (QAPI)
- Infection Prevention and Control
The memo summarizes updates to the Chemical Restraints and Unnecessary Psychotropic Medication as follows: The regulations and guidance for the unnecessary use of psychotropics (F758) have been incorporated into F605. This change will help to streamline the survey process, increase consistency, and strengthen our message that facilities must prevent the unnecessary use of psychotropic medications. The guidance regarding “convenience” has been revised to include situations when medications are used to cause symptoms consistent with sedation and/or require less effort by facility staff to meet the resident’s needs. Additional guidance has been added to emphasize requirements related to the right to be fully informed of and participate in or refuse treatment, noting that before initiating or increasing a psychotropic
medication, the resident must be notified of and have the right to participate in their treatment, including the right to accept or decline the medication. Unnecessary Medications (F757) has been revised to only include guidance for non-psychotropic medications. The revised Unnecessary Medications, Chemical Restraints/Psychotropic Medications, and Medication Regimen Review Critical Element Pathway also includes investigative elements to align with the revised guidance.
CMS Resources COE-NF Resources COE-NF is available to support facilities as they review their practices around psychotropic medications and care planning.
Surveyors will begin using this guidance to determine compliance with survey requirements on February 24,
2025. | | | | | The Nursing Facility ICPG and the OIG's General Compliance Program Guidance (GCPG) apply to all individuals and entities in the health care industry and provide an updated and centralized resource for
voluntary compliance program guidance for nursing facilities. Nursing facilities can use this guidance to identify their unique risks and implement compliance and quality improvement strategies to mitigate them.
The Nursing Facility ICPG describes: - Risk areas for nursing facilities
- Recommendations and practical considerations for mitigating those risks
- Other
important information OIG believes nursing facilities should consider when implementing, evaluating, and updating their compliance and quality programs.
Of note, pages 18-23 address changes in resident demographics, including behavioral health needs and appropriate use of medications. Click Here to learn more. |
| | The COE-NF can help customize training events and provide technical assistance for behavioral health risk areas for your nursing facility.
| | | |
|
| Nursing Facility Guidance: Comprehensive Assessment | | |
According to the CMS State Operations Manual - Appendix PP §483.24(c)(1), the facility must provide (based on the comprehensive assessment, care plan and the preferences of each resident) an ongoing program to support residents in their choice of activities – both facility-sponsored group and individual activities and independent activities – to meet the interests of and support the physical, mental, and
psychosocial well-being of each resident, encouraging both independence and interaction in the community.
F679, Activities Meet Interest/Needs of Each Resident, intends to ensure facilities implement a resident-centered activities program that reflects residents' interests and cultural preferences, enhancing their physical, mental, and psychosocial well-being and independence. It aims to create meaningful opportunities for residents, supporting their domains of wellness: security, autonomy, growth, connectedness, identity, joy, and meaning.
A lack of opportunity to engage in meaningful and enjoyable activities can result in boredom, depression, and behavior disturbances. Individuals vary in their preferred activities, reflecting unique personalities, past interests, perceived environmental constraints, religious and cultural backgrounds, and changing physical and mental
abilities.
What can you do TODAY?
Ensure you obtain information directly from the resident using their preferred language. If they are unable to communicate, conduct interviews with family or a significant other who is familiar with the resident.
Use the MDS 3.0 and Care Area Assessment to identify residents who have withdrawn from activities or may feel uneasy about participating in activities and forming social relationships. Collaborate with social services to implement interventions that enhance mental health.
Involve the interdisciplinary team (IDT) in collaborating on individualized daily care and activity planning. According to the Minimum Data Set 3.0 Resident Assessment Instrument User’s Manual v1.19.1, care plans should address the root causes of activity limitations and include activity programs tailored to each resident's interests and abilities to enhance their quality of life.
Use the Addressing Residents Goals, Preferences, and Priorities (GPPs) from the Moving Forward Coalition
to help identify, document, and deliver person-centered resident care.
Follow the Activities Critical Element Pathway in Survey Resources (ZIP) on the Nursing Homes | CMS website to ensure the facility meets the resident's activity needs. |
| | | The COE-NF stands ready to support your facility in these guidance areas. Contact us today: | | | | Honoring Culture and Traditions in Nursing Facilities During the Holidays | | | | | Nursing facilities care for a diverse population of residents, each with unique cultural practices, traditions, and beliefs. During the holiday season, it is essential to be mindful of these differences to ensure no resident feels overlooked or excluded.
| | | Recognizing, honoring, and celebrating a variety of cultural practices and traditions not only enhances residents' holiday experience but also promotes joy, connection, and respect within the community. Taking the time to incorporate diverse traditions and activities creates an environment where everyone feels seen, heard, and truly part of the celebration.
For some residents, finding joy during the holidays can be challenging. The "holiday blues" are an authentic experience, often bringing sadness, loneliness, or stress. Providing thoughtful support during this time is essential to help residents navigate these emotions and feel connected, cared for, and valued. | |
| | Subject Matter Expert Article | | | | Keeping you up to date with the latest research, advancements and best practices in managing and addressing behavioral health conditions in nursing facilities. | | |
| The ABCDs of Supporting Residents’ Mental Health During the Holiday Season | | |
“It’s not how much we give, but how much love we put into giving.” –Mother Theresa
The holiday season can bring to the forefront a wide range of emotions for nursing home residents. While it is an opportunity to celebrate and create joyful memories, it can also bring about feelings of loneliness, sadness, or anxiety, especially for
those who may be separated from family or who have experienced significant loss. During this time, the role of nursing home staff becomes crucial in supporting residents' mental and emotional well-being. Nursing home staff can use the ABCD acronym as a helpful guide to support residents' mental well-being and foster feelings of joy.
Appreciation: Staff should encourage and participate in residents' expressions of gratitude, celebrating the positive aspects of their lives. Introducing gratitude practices, such as brief meditations where residents reflect on what they are thankful for, helps foster a positive mindset. Additionally, music and holiday rituals hold special meaning in many cultural and spiritual traditions. Staff can support residents in engaging with these cherished practices, enhancing their sense of connection and joy during the holiday
season.
Balance: While the holiday season can bring joy, it may also evoke sadness or stress for many residents. Staff play a vital role in recognizing and supporting residents through these challenging emotions. Encourage a healthy balance by allowing residents to express their grief and manage stress through relaxation techniques while also inviting them to experience moments of joy by participating in community celebrations and activities. It is essential to meet residents where they are emotionally, respecting their individual needs and pacing.
Community: For nursing home residents, fostering a sense of connection is essential to their emotional well-being. Staff can enhance this sense of belonging by creating inclusive opportunities for residents to connect with others, including family, friends, and pets. These moments of togetherness
can make the season truly special and uplifting for everyone involved.
Dialogue: Open and meaningful dialogue ensures that each resident feels heard, valued, and included during the holiday season. For nursing home staff, engaging in thoughtful conversations with residents—ideally several weeks in advance—can provide valuable insights into their preferences and needs. These discussions can uncover how residents wish to celebrate the traditions or customs that hold special meaning to them. By initiating these conversations early, staff can tailor the holiday experience to reflect each resident’s unique cultural, spiritual, and emotional needs, ensuring a more inclusive and meaningful celebration. | |
| | Have mental illness and substance use questions? We have the answers! Join us for office hours to talk with the experts. | | | Managing Substance Use Disorders in Nursing Facilities
Interested in receiving expert answers to substance use challenges you are facing in your nursing facility? Join Dr. Jen Azen and Dr. Swati Gaur, subject matter experts, as they answer questions related to your complex cases. No question is too big or too small!
Join our monthly office hours on the third Friday of each month from 1-1:30 p.m. ET to get answers directly from the experts working in nursing facilities!
Audience: Appropriate for clinicians, nurses, administrators, and social workers. | |
| | | Seasonal Affective Disorder is a type of depression that occurs during specific seasons, usually fall or winter. The COE-NF created the following resources on Seasonal Affective Disorder to help nursing facilities educate their staff. Take a moment to review the resources below to learn more. |
| | | | Seasonal Affective Disorder Fact
Sheet
Learn the signs and symptoms of Seasonal Affective Disorder. Download Resource | | | | | Seasonal Affective Disorder Checklist
Learn ways to reduce the impact of Seasonal Affective Disorder on residents. Download Resource |
| | | | Don’t Be
SAD
Discover tips to manage the effects of Seasonal Affective Disorders. Download Resource | | |
|
Interested in accessing additional COE-NF resources for your facility?
| | | | | | Seasonal Affective Disorder (SAD) symptoms can also occur during the spring and summer months. It is referred to as summer-pattern SAD. | | | | | | | This December, join expert-led webinars designed to help you better support residents’ mental health. Topics include suicide
prevention, managing grief, seasonal depression, and mental health first aid. Gain practical strategies, earn continuing education credits, and make a difference in residents’ lives.
Register today - spaces are limited! | | |
Question, Persuade, Refer (QPR) |
| |
| Suicide Prevention Training
**Registration Closed: This session is now full** | | Tuesday, December 10, 2024
2-3:30 p.m. ET 1.5 ACCME & 1.5 NAB credits will be
offered. QPR training will offer strategies to support your work in providing suicide prevention and mental wellness to your residents. This 1.5-hour evidence-based instructor-led training is held virtually and will provide a comprehensive review of a three-step approach anyone can learn to help save a life from suicide. This session will provide a one-year certification to attendees.
Key components covered in the training: - How to Question, Persuade and Refer someone who may be suicidal.
- How to get help for yourself or learn more about preventing suicide.
- The common causes of suicidal behavior.
- The warning signs of suicide.
- How to get help for someone in crisis.
| | | Supporting Healing From Grief and Loss in Nursing Facilities | | | | Thursday, December 12, 2024
2-3 p.m. ET 1.0 ACCME & 1.0 NAB credits will be offered.
Grief and loss symptoms from resident death are often similar to those experienced from family or friend loss. This webinar session will provide an overview of the
bereavement concerns that can arise when nursing home residents and staff experience the death of a resident. Content will review the emotional and psychological responses to loss through the five stages of grief. The discussion will further inform on postvention activities to support self-care and healing for residents and nursing home staff.
Learning objectives: - List types of grief and symptoms.
- Define the five stages of grief and potential impacts.
- List strategies for self-support and healing.
- Identify facility "postvention" activities to support nursing facility staff and residents after loss. List practical strategies for building resiliency.
| | | | | Holiday Seasonal Depression: Ways to Support Nursing Facility Residents |
| |
Tuesday, December 17, 2024
2-2:30 p.m. ET 0.5 ACCME & 0.5 NAB credits will be offered.
The fundamentals of Seasonal Affective Disorder (SAD) and its effects on holiday depression will be discussed. This training is designed to provide participants with a basic understanding of depression, seasonal onset, symptoms, and treatments to support residents experiencing challenges from SAD. Learning Objectives:
- Gain a basic understanding of seasonal depression during the holidays.
- Recognize and understand the signs, symptoms, and triggers of seasonal depression.
- Learn helpful
responses to engage with residents.
| | | | | Treating Older Adults in Recovery: Grief and Complex Bereavement in Older Adult Community | | | | Thursday, December 19, 2024
2-3 p.m. ET 1.0 ACCME & 1.0 NAB credits will be offered.
In this informative session, losses such as deaths, the ending of careers, relocations, health, and other losses will be examined, and solutions to grief will be presented. There is an emphasis on not
being alone and connecting with grief support groups, filling a memory box, creating a grief journal and discovering alternatives such as participating in new hobbies, adopting a pet, volunteering or dating in cases of spousal deaths. Reactions of grief, dealing with holidays and reviewing one’s spirituality will be explored. Positive actions in bereavement, self-care, and assistance for the bereaved will also be discussed. Resources will be available.
Learning objectives: - Discern the difference between grief in older adults and how it may differ from younger people.
- Describe effective support and communication with older adults in grief and bereavement.
- Describe ways to direct individuals to continue with a quality life starting over in a different realm.
| | |
Mental Health First Aid (MHFA) | | | | **Registration Closed: This session is now full** |
| | | Friday, December 20, 2024
11 a.m.-4:30 p.m. ET
7.75 NAB credits and 5.5 ACCME credits will be offered after completing the live training.
Mental Health First Aid (MHFA) training provides skills to engage and provide initial help and support to someone developing a mental health or substance use challenge or experiencing a crisis.
This session provides a MHFA certification for three years.
The training covers: - Common signs and symptoms of mental health and substance use
challenges.
- How to interact with a person in crisis.
- How to connect a person with help.
- Expanded content on trauma, substance use and
self-care.
The training is divided into three parts:
Part 1 starts AFTER initial registration has been APPROVED by the instructor. Approved registrants will be emailed instructions on how to create an online profile using MHFA Connect and complete a pre-survey/quiz followed by a two-hour self-paced online course. Registrants MUST complete Part 1 no less than 48 hours (two business days) prior to the scheduled Part 2 session.
Part 2 is a 5.5-hour live instructor-led virtual training. Participants are required to be on camera the
entire time.
Part 3 participants will return to MHFA Connect to complete the post-test and evaluation, which is required to receive a certificate of participation. | | | "Self-care means giving yourself permission to pause." – Cecilia Tran
| | |
| The holiday season is a time to give, share, and show appreciation for those around us. But amidst the celebrations, do not forget to invest in yourself. Sometimes, the most meaningful deposits we can make require no currency—just time, care, and self-reflection. Try these three tips to nurture your well-being, and you’ll be better equipped to spread joy to others. | | |
|
Cultivate gratitude – Practicing gratitude shifts your focus from what you feel may be missing to recognizing all that you already have, fostering a deep sense of contentment and peace.
Connect with your senses – Spending time in nature, listening to calming music, or trying aromatherapy are powerful ways to reconnect with yourself while decluttering your mind.
Unplug – Silence your notifications, indulge in a pampering activity, and remember, it is okay to politely say no when you need to protect your energy. |
| | | |
Join our text message list!
Scan the QR code or click the button below to sign up and receive text
notifications from COE-NF.
Stay up-to-date on COE-NF news and events. | | | | | | | Contact us:
For more information, please call 1-844-314-1433 or email coeinfo@allianthealth.org.
To submit a request to inquire about substance use and/or mental health training options for your facility, complete the inquiry form.
Was this email forwarded to you? If so, please subscribe HERE.
Want to opt-out from receiving news from us? Click HERE to unsubscribe. | | |
| Click below to follow the COE-NF social media channels for resources, news and more! | | |
| | | Alliant Health Solutions (AHS) was awarded a three-year cooperative agreement from the Substance Abuse and Mental Health Services Administration (SAMHSA), in collaboration with the
Centers for Medicare & Medicaid Services (CMS), to create the COE-NF. AHS has over 50 years of experience working with nursing facilities and behavioral health in nursing facilities. | | | | | This newsletter was made possible by grant number 1H79SM087155 from the Substance Abuse and Mental Health Services Administration (SAMHSA). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Substance Abuse and Mental Health Services
Administration. | | | | | | |
