Long term/post-acute care providers may be thinking of the facility assessment as just another paper regulation that detracts from the day-to-day business of providing care to the increasingly frail and acute population. Alternatively, providers can approach it as an opportunity to identify gaps between the care needs of the residents being treated and the facility competencies and environment. In turn, this could help to avoid an adverse event, or to focus on the center’s Quality Assurance & Performance Improvement (QAPI) plan.

The latter requires a deep dive into the needs of residents, staff competencies, and physical environment. The biggest gaps are often not in the areas where the center specializes and has the greatest strengths, but in the care areas provided less frequently.

For example, centers that provide care for numerous residents with dementia are more likely to have competencies in dementia care and a physical plant that works well for individuals with dementia. The same could be said for centers that provide care for many post-acute stroke admissions or those in need of orthopedic rehabilitation.

One of the most widely demonstrated relationships in health care is the relationship between volume of care and outcomes for that type of care, and our work has found this relationship persists in skilled nursing facilities (SNFs). Centers that treat a significant volume of any type of problem tend to be better at treating that problem. Not surprisingly, through specialization they gain experience in it and, over time, build the competencies and the facilities to treat it.

The challenge for most nursing centers is that they generally admit many types of residents, and that the residents they admit have a multiplicity of problems. Centers often treat a mix of post-acute and long-term residents with various medical, cognitive, and functional problems. As the population of nursing center residents has become increasingly frail and acutely ill, the challenge of being competent in care for all types of residents has become greater.

This is where the facility assessment can help. Start by looking over the prior year at the residents that have been treated and at the volume of different types of care provided. Pay attention not only to the care provided most frequently, but also to the care provided less often.

Next, determine whether there is an adequate number of staff who are competent at providing care to many of the residents. Pay special attention to the care provided less frequently, as the center may contract for these services or depend on only a few staff members. Finally, identify gaps in services, and then develop a QAPI plan to fill those gaps.

This challenge even extends to cultural competencies of staff in caring for residents of different ethnicities.
Here again, some centers provide care to a range of ethnic groups in small numbers, while others treat primarily one ethnic group. Whatever your ethnic mix, cultural competence can be a challenge, a challenge faced throughout health care. Pay particular attention to basic needs such as life-long foods and routines, as well as varying cultural views and practices that arise toward the end of life.