The new facility ratings for nursing homes that came into force on Thursday have led to mixed reviews of their suitability among nursing home operators.

Feedback ranges from the view that assessments are a surprisingly useful tool for improving communication transparency and fine-tuning staffing needs to the ever-changing condition of patients, to concerns that they are costly and unnecessary.

These updated facility assessments, required by the Centers for Medicare & Medicaid Services (CMS), are the first in a series of requirements under the federal government’s broader workforce mandate and are designed to ensure facilities are better prepared 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 Clinical Officer at the Evangelical Lutheran Good Samaritan Society, to explore how these assessments have impacted their operations.

Although the obligation to carry out annual asset assessments has been in place for some time, recent changes have led some operators to change their practices, resulting in increased administrative burdens.

“We have invested a lot of time and resources,” Sandgren told SNN. “To date, our teams have spent more than 1,400 hours updating the asset assessment reports to align with the new standards. In other words, that’s 175 eight-hour work days that we have invested in this work.”

And despite the preparation, some of the requirements seemed vague, while others were repetitive, Sandgren said.

“This is a formality that does not improve quality. Instead, it leads to redundant documentation and additional administrative burden for our staff,” said Sandgren.

As an example, Sandgren pointed to a new component of the facility assessment in the area of ​​behavioral health, even though there are already eight existing citations related to behavioral health requirements.

She said this and other components required in the updated facility assessment are “duplications” of existing rules in the State Operations Manual (SOM), which contains key rules and guidelines for inspections and certifications.

Good Sam is the second-largest multi-site senior living organization in the United States with 126 residential communities, including 46 nursing homes, according to the 2023 LeadingAge Ziegler 200 list. Although Good Sam operates in multiple states, it consolidated its operations from 22 states to seven earlier this year.

Some positive first impressions

For other operators, however, the requirements of the plant assessment were unexpectedly positive.

“In terms of transparency, (the facility assessment) provides better communication about how we utilize our staff, how we work to meet residents’ needs, how we work with families, residents and staff,” Stennett said of Avamere’s implementation of facility assessments. “It puts everyone on the same page.”

This forced operators to adjust staffing levels to suit the severity of the disease and the needs of the patients, she said.

For other large, for-profit SNF operators, however, the facility evaluations were not a major challenge at all and even led to some important insights for quality improvement.

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

“We completed our assessments about two weeks ago and have already developed plans to meet the requirements of the mandate if and when it comes into full effect,” Nee said.

Based in Brentwood, Tennessee, Diversicare operates more than 75 nursing homes and assisted living facilities with approximately 8,500 beds. Diversicare focuses on rural areas and provides a range of health care services, including skilled nursing and other specialized ancillary services.

Nee said Diversicare’s proactive approach to assessments, aided by a slightly longer five-year time frame for rural facilities due to the location of Diversicare sites in those areas, will allow Diversicare facilities to make any staffing changes should the mandate eventually go into effect.

And although the assessments brought new requirements, the process was manageable because Diversicare facilities already conducted annual assessments, Nee said.

“It’s really going to come down to how we improve our clinical skills and the skills of our team to meet the needs of the residents that we can accommodate. So I would say (the facility assessment) was very useful in that regard,” Nee said.

It also allows facilities to take emergency preparedness and resident feedback into account, he said.

“So it’s really a good holistic approach to make sure we can meet the needs of our new patients and residents,” Nee said.

Stennett expressed a similar opinion about Avamere, which has mid-sized operations in the Pacific Northwest.

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

Avamere operates 33 nursing homes in Oregon and Washington, including five campuses with on-site assisted living, assisted living and dementia care facilities.

One of the main objectives of the updated site assessments is to determine future staffing needs. Nee stressed the importance of this aspect.

Nee noted that as patient volumes increase in SNFs, it is critical that facilities adapt their staffing and training to meet these new challenges. The updated assessments provide valuable data for planning and resource allocation.

Overcoming the challenges

Despite the benefits, implementing updated facility assessments also presents challenges. For many facilities, particularly those that are part of smaller SNSF operations, the process can be challenging, particularly in terms of integrating new requirements and maintaining regulatory compliance while considering other operational pressures.

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

Stennett also noted that the assessments led to a re-evaluation of Avamere’s approach to staffing and resident care.

Aside from the rewards, there is no doubt that asset valuations have increased administrative burdens for some.

“We have a team at the corporate level that has developed numerous resources and guidelines for our nursing home leaders based on our interpretation of these facility assessment requirements,” Sandgren said. “We have held trainings to answer questions and provide clarity where needed. We have developed a template for our sites to use to conduct the facility assessment that automatically pulls data from MDS systems.”

In addition, some functions could not be centralized, and the ultimate responsibility for conducting the facility assessment lay with the administrator of each Good Sam site.

“Ultimately, this keeps us from doing our most important work: caring for the residents,” Sandgren said.