The new facility assessments for nursing homes, which went into effect on Thursday, are prompting mixed reviews from nursing home operators regarding their utility.

The feedback ranges from assessments being a surprisingly useful tool for enhancing transparency in communication and fine-tuning staffing needs for ever-changing patient acuity, to concerns that they are costly and redundant.

These updated facility assessments required by the Centers for Medicare & Medicaid Services (CMS) are first in the series of requirements of the broader federal staffing mandate, and aim to ensure that facilities are better equipped to meet the evolving needs of their residents.

Skilled Nursing News spoke with Steve Nee, CEO of Diversicare Healthcare Services, Roxy Stennett, COO at Avamere Living, and DeeAndra Sandgren, chief nursing officer at The Evangelical Lutheran Good Samaritan Society, to explore how these assessments have impacted their operations.

Quantifying the extra effort

While the annual facility assessments requirement has been in place for quite some time, the changes finalized recently have caused some operators to shift practices, thus introducing administrative burdens.

“We have invested significant time and resources,” Sandgren told SNN. “To date, our teams have spent more than 1,400 hours updating facility assessment reports to align with the new standards. Put another way – that’s 175 eight-hour work days that have been put into this effort.”

And, despite being prepared, some of the requirements appear vague while others are repetitive, Sandgren said.

“This is a formality that does not move the needle on quality. Instead, it adds documentation redundancy and administrative burden on our people,” Sandgren said.

As an example, Sandgren pointed to a new behavioral health component of the facility assessment, even as there are eight existing citations related to behavioral health needs.

This and other other components required in the updated facility assessment, she said, are “duplicative” of pre-existing rules in the State Operations Manual, or SOM, which contains the primary survey and certification rules and guidance.

Good Sam is the second-largest multi-site senior living organization 132 skilled nursing facilities across 17 states. While Good Sam has operations across several states, the organization announced earlier this year that it plans to consolidate its operations from 22 states to seven.

Some positive early impressions

For other operators, however, the facility assessment requirements have been unexpectedly positive.

“As far as transparency, [facility assessment] offers better communication about how we’re staffing, how we work to receive or meet the resident needs, how we partner with families and residents and staff,” said Stennett of Avamere’s adoption of the facility assessments. “It is keeping everybody on the same page.”

It has forced operators to adjust staffing based on acuity and patient needs, she said.

Meanwhile, for some mid-sized to large for-profit SNF operators, the facility assessments haven’t been a heavy lift at all, while completing them has even led to some key insights for improving quality.

For Diversicare, a larger-sized operation with mostly rural facilities, the initial experience with the updated facility assessments has been largely positive, Nee told SNN. He believes that the assessments have been a valuable exercise in self-reflection and improvement, rather than a hindrance.

“We finished our assessments about two weeks ago and have already put together plans to meet the mandate’s requirements if and when they fully take effect,” Nee said.

The Brentwood, Tennessee-based Diversicare operates more than 46 long-term care centers with about 4,500 beds. Diversicare, which focuses on rural areas, offers a range of health care services including skilled nursing and other specialized ancillary services.

Nee said that Diversicare’s proactive approach with the assessments, aided by a somewhat extended timeline of five years for rural facilities due to Diversicare locations being in these areas, will allow Diversicare facilities to incorporate any staffing changes should the mandate be in force eventually.

And while the assessments introduced new requirements, the process was manageable since Diversicare facilities were already conducting assessments annually, Nee said.

“It’s really going to be a matter of how we hone our clinician skills and our team’s skill sets to be able to meet the needs of those residents that we are able to admit. So I would say that, yes, [the facility assessment] was very beneficial in that regard,” Nee said.

Moreover, it allowed facilities to factor in emergency preparedness and resident feedback, he said.

”So it really is a good holistic approach for making sure that we are able to meet the needs of our incoming patients and residents,” Nee said.

As for Avamere, which has mid-sized operations in the Pacific Northwest, Stennett echoed a similar sentiment.

“I don’t think it was a giant administrative burden,” said Stennett. ”It was a great exercise to evaluate where we are and to partner more with our residents and families on staffing and needs,” she said.

Avamere operates 33 skilled nursing facilities in Oregon and Washington, including five campuses with independent living, assisted living, and memory care onsite.

One of the core objectives of the updated facility assessments is to determine future staffing requirements. Nee highlighted the importance of this aspect.

Nee noted that as patient acuity levels rise at SNFs, it is crucial for facilities to adapt their staffing and training to meet these new challenges. The updated assessments provide valuable data for planning and resource allocation.

Navigating the Challenges

Despite the benefits, the implementation of updated facility assessments is not without its challenges. For many facilities, especially those that are part of smaller-sized SNF operations, the process can be demanding, especially in terms of integrating new requirements and maintaining compliance while addressing other operational pressures.

However, Nee emphasized the value of the assessments. While there are challenges, the assessments provide an opportunity to enhance services and ensure that facilities are well-prepared for future needs, he said.

Stennett also noted that the assessments have prompted a reevaluation of how Avamere approaches staffing and resident care.

The fruits aside, there is no doubt that the facility assessments have raised administrative burdens for some.

“We have a corporate-level team that developed numerous resources and guidance for our nursing home leaders based on our interpretation of this facility assessment requirement,” Sandgren said. “We’ve held education sessions to answer questions and provide clarity as needed. We developed a template for our locations to use to complete the facility assessment, which automatically pulls data from MDS systems.”

Moreover, some functions could not be centralized, and the administrator in each Good Sam location was ultimately responsible for completing the facility assessment.

“At the end of the day, this takes us away from our most important work: caring for residents,” Sandgren said.