| Increasing Accessibility for Residents with Low Vision | <p style="text-align:center;"><img src="/Articles/PublishingImages/2025/iStock-1077244500.jpg" alt="" style="margin:5px;width:500px;height:334px;" /></p><p>Across the world, the population is aging rapidly, and with age comes a greater risk of certain health conditions; among these, vision loss is one of the most significant.</p><p>According to the Royal National Institute of Blind People (RNIB), more than half of residents in assisted living or care homes are blind or have low vision. Long term care facilities cannot afford to treat vision loss as a marginal issue.</p><p>Yet, many care facilities can have challenges in offering an accessible experience. Menus, schedules, signage, and paperwork are designed primarily in print formats, leaving residents dependent on staff for even the smallest of tasks. This in turn can lead to other significant issues that impact both residents and care staff alike, including reduced resident independence, increased staff strain, unhappy and disconnected family members, and potentially reduced profits.</p><h3>The Cost of Inaccessible Care Environments</h3><p>When accessibility for blind and low-vision residents is overlooked by a care provider, they face many avoidable challenges. Reading a meal plan, finding a room, or completing paperwork are daily tasks that many residents are very capable of doing. But for others, that independence can be lost as they would require staff interpretation and support even for simple tasks such as these.</p><p>Many care providers often don’t see an issue here, as they are still helping the individual and providing support. However, the problem has implications.</p><p>For residents who are blind or have low vision, they can very quickly feel a loss of independence, frustration, and in some cases, it can even affect their mental well-being.</p><p>For care facilities, spending a minute or two assisting a resident with reading a menu, for example, might not seem like a lot, but dozens of requests a day soon add up and can take away from critical care giving. By providing accessible solutions, this time can also be saved.</p><p>When you consider that 96 percent of assisted living facilities and 99 percent of nursing homes in the United States are experiencing staffing shortages, according to The American Health Care Association, every minute of staff time saved is hugely beneficial.</p><h3>The Benefits of Improving Accessibility </h3><p>Accessibility should never be a box-ticking exercise. It goes far beyond compliance and legislation. When care organizations embed accessibility into the core of their operations, they can benefit from;</p><h4>1.    Reduced strain on staff members.</h4><p>With staffing shortages, hiring a new nurse or caregiver can be challenging and existing staff members often have a full plate. When care is accessible for blind and low-vision individuals, however, what would otherwise be frequent micro interventions (reading menus, accessing schedules, and help with choosing clothes to wear) can now be done independently by the resident.</p><p>This reduces strain on staff by freeing up time and gives them additional capacity to do medication rounds, for example. Reduced strain on staff helps mitigate the costs of labor shortages.</p><h4>2.    Boost in resident satisfaction.</h4><p>When blind and low-vision residents are able to carry out daily tasks with independence, they enjoy a greater quality of life, feel less isolated, and in general are likely to feel happier and more satisfied with the long term care facility they are living in.</p><p>This increase in resident satisfaction can reduce turnover and potentially bring in additional business through word of mouth.</p><h4>3.    Improved family confidence.</h4><p>Putting a loved one in care is an emotional journey for families. Oftentimes, several family members are involved in the process, and the well-being of their loved one is the top priority. When a resident is unhappy, this extends to their family, who, over time, can lose trust and confidence in a facility. On the flip side, when a resident feels confident, independent, and empowered, their family typically feels the same.</p><p>Accessible care means happy residents and a family that has confidence in the facility they have put their trust in. As with the boost in resident satisfaction, this can also help reduce resident turnover and bring in new business.</p><h3>How Technology Can Improve Accessibility</h3><p>When businesses think about accessibility, one of the first things that comes to mind is cost. While implementing accessibility solutions will come with a cost, the long-term benefits outweigh this many times over.</p><p>The truth is, providing accessible care doesn’t need to cost hundreds of thousands or take years to update buildings, thanks to the latest advancements in technology. While there are many physical adjustments to facilities that can also be made to improve accessibility, one of the biggest advancements is AI.</p><p>For blind and low-vision people, AI has been particularly useful. Specific AI software can, for example, interpret menus and activity timetables from a photo and read these aloud to a resident. With forms and paperwork, a blind resident can take a photo, upload it to an AI platform, and get an almost instant, detailed description of what it is.</p><p>AI, when implemented correctly within a care facility, truly enables greater independence for the blind and low-vision community. Care providers who recognize this now will benefit for many years to come, along with their staff and residents.</p><h3>Where to Start?</h3><p>As a care provider wanting to improve accessibility, the first place to start is by conducting a resident and family satisfaction survey. This not only highlights where frustrations currently exist but also signals to families that their voices matter.</p><p>From there, care home managers should take the time to speak directly with blind and low-vision residents in one-on-one conversations. No checklist or policy can replace the insights gained from lived experience, and residents will often suggest simple, inexpensive improvements that make a meaningful difference in their day-to-day lives.</p><p><span><img src="/Articles/PublishingImages/2025/andy%20bailey.png" alt="Andy Bailey" class="ms-rtePosition-2" style="margin:5px;" /></span>With this feedback in hand, the next step is to carry out a thorough accessibility audit. This includes evaluating menus, signage, activity boards, paperwork, and the technology currently in use, alongside the physical environment.</p><p>Finally, facilities should prioritize any quick wins identified from the surveys and audit. This might be something as simple as offering large-print or braille menus or having a strategy for implementing technology solutions.<br><br><em>Andy Bailey is chief marketing officer at Be My Eyes, an accessibility management platform for people who are blind or have low vision. </em><br></p> | 2025-11-04T05:00:00Z | <img alt="" src="/Articles/PublishingImages/740%20x%20740/AAseniorwoman_ipad.jpg" style="BORDER:0px solid;" /> | Management | Andy Bailey | According to the Royal National Institute of Blind People, more than half of residents in assisted living or care homes are blind or have low vision. Long term care facilities cannot afford to treat vision loss as a marginal issue. |
| Using Psychological Safety to Build a QAPI Culture | <p><img src="/Articles/PublishingImages/740%20x%20740/healthcare-staff.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:350px;height:350px;" />Quality assurance and performance improvement (QAPI) has the potential for meaningful change as long as it is not reduced to a compliance exercise—documents filed away, minutes recorded, and action items noted. </p><p>The facilities that thrive are those that treat QAPI as a culture, not a checklist. And at the heart of that culture is psychological safety—the belief that every staff member, from the CNA to the administrator, can speak up, share ideas, and challenge processes without fear of punishment.</p><h3>Defining Psychological Safety in QAPI</h3><p>Psychological safety, a concept rooted in organizational behavior research, describes the sense of confidence that one’s voice will be heard and valued. In health care, where hierarchies are deeply ingrained, psychological safety is essential.</p><p>For QAPI teams, psychological safety transforms meetings from routine compliance updates into vibrant problem-solving sessions. It ensures that concerns are raised before they become citations, and that creative solutions are not stifled by fear of reprisal.</p><h3>The Four Dimensions of Psychological Safety</h3><p>To intentionally build psychological safety in QAPI culture, leaders must focus on four dimensions.<br>1. Learner Safety<br>“It’s safe to discover, ask questions, make mistakes, and learn.”<br></p><ul><li>Normalize curiosity by celebrating questions rather than dismissing them.</li><li>Protect new learners with coaching and just-in-time education.</li><li>Reframe mistakes as learning opportunities for system improvement.</li></ul><p>2. Inclusion Safety<br>“It’s safe to belong, regardless of role, title, or background.”<br></p><ul><li>Audit who is at the QAPI table—are CNAs, dietary staff, and housekeeping included?</li><li>Use inclusive language and invite contributions from all disciplines.</li><li>Honor diverse perspectives, recognizing that every role contributes to resident outcomes.</li></ul><p>3. Collaborator Safety<br>“It’s safe to share openly and interact without fear of rejection.”<br></p><ul><li>Facilitate shared decision-making, ensuring no single voice dominates.</li><li>Rotate roles in QAPI meetings to empower frontline staff.</li><li>Encourage peer-to-peer communication and model active listening.</li></ul><p>4. Challenger Safety<br>“It’s safe to speak up, challenge norms, and offer bold ideas.”<br></p><ul><li>Praise constructive pushback and reward curiosity.</li><li>Separate reporting from punishment—focus on transparency over blame.</li><li>Use real-time root cause analysis (RCA) to uncover issues, not to assign fault.</li></ul><p>When all four quadrants are present, staff can move from passive compliance to active engagement in improvement.</p><h3>Practical Strategies to Build Psychological Safety into QAPI</h3><p>Changing culture requires deliberate action. Facilities can begin by implementing these strategies.</p><ul><li>Embed QAPI into Daily Operations</li></ul><p>Culture is built in moments, not meetings. Make QAPI language part of shift huddles, care plan reviews, and daily problem-solving.<br></p><ul><li>Recognizing Contributions Publicly</li></ul><p>Acknowledge staff input during rounds, newsletters, or team huddles. Recognition reinforces the value of participation.<br></p><ul><li>Establish a “QAPI Champion” Role</li></ul><p>Designating staff as champions ensures quality improvement is carried between formal meetings and daily routines.<br></p><ul><li>Train Leaders to Coach, Not Correct</li></ul><p>Leadership tone makes or breaks psychological safety. Coaching builds confidence; criticism silences voices.<br></p><ul><li>Create a QAPI Rhythm Calendar</li></ul><p>Consistent, predictable cycles of data review and performance improvement build trust and engagement.<br></p><ul><li>Incorporate QAPI Into Orientation and Onboarding</li></ul><p>New staff must see QAPI not as leadership’s project, but as the facility’s way of operating.</p><h3>Why Psychological Safety Is the Foundation of Sustainable QAPI</h3><p>QAPI is only as strong as the culture that sustains it. A compliance-driven approach produces binders of data but little change. A culture-driven approach, fueled by psychological safety, produces staff who bring forward problems, propose solutions, and feel ownership in the quality journey.</p><p>The difference is visible:<br></p><ul><li>Staff engagement improves.</li><li>Residents receive more consistent, person-centered care.</li><li>Facilities move from reacting to citations to proactively solving problems.</li><li>Performance improvement plans (PIPs) become living projects rather than paper exercises.</li></ul><p>Ultimately, psychological safety transforms QAPI from a task into a tool of transformation.</p><h3>Final Reflection for Leaders</h3><p><span><span><em><img src="/Articles/PublishingImages/2025/Veronica-Ceasar.jpg" alt="Veronica Ceaser" class="ms-rtePosition-2" style="margin:5px;" /></em></span></span>As you reflect on your facility, ask yourself:<br></p><ul><li>Which quadrant of psychological safety: learner, inclusion, collaborator, challenger is weakest?</li><li>What is one actionable step you can take this month to strengthen it?</li></ul><p>The answers to those questions will determine whether QAPI in your facility remains a compliance exercise or becomes the cultural engine that drives lasting quality improvement.<br><br><em>Veronica Ceaser is a long term care consultant and the founder of GEM Healthcare Consulting. With a background spanning bedside nursing to executive leadership, she specializes in MDS training, quality improvement, and regulatory readiness for skilled nursing teams across the U.S.</em><br></p> | 2025-10-30T04:00:00Z | <img alt="" src="/Articles/PublishingImages/740%20x%20740/healthcare-staff.jpg" style="BORDER:0px solid;" /> | Quality Assurance and Performance Improvement;Quality | Veronica Ceaser, MSN, RN | QAPI has the potential for meaningful change as long as it is not reduced to a compliance exercise—documents filed away, minutes recorded, and action items noted. |
| Improving Section GG Accuracy Through QAPI | <p><img src="/Articles/PublishingImages/2025/iStock-464806966.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:250px;height:249px;" />Accurate data collection and reporting are more important than ever in skilled nursing facilities. Among the challenges is coding section GG of the Minimum Data Set (MDS) that captures usual performance in self-care and mobility tasks. This data also drives care planning, quality reporting, Medicare reimbursement, and, in some states, Medicaid reimbursement, so it has a widespread impact. Thus, addressing and resolving the root cause of any inaccuracies and inconsistencies in a timely way must be a top priority.</p><p>Common issues are incomplete or missing observations, inconsistent input across disciplines, or the lack of an interdisciplinary effort to determine usual performance. The quality assurance and performance improvement (QAPI) process is an effective method for facility teams to identify and address the root causes of these issues.</p><p>QAPI is designed to be a proactive, data-driven framework that goes beyond compliance to focus on measurable and sustainable improvements. This article shows how to include section GG in the QAPI process. It will help ensure improved accuracy of documentation and coding and also establish a lasting system of accountability and collaboration.</p><h3>The Role of Section GG in QAPI</h3><p>Section GG lends itself well to QAPI monitoring because it provides clear, measurable indicators of compliance. Facilities can begin by routinely auditing a sample of assessments each quarter, at least 5 percent of all completed MDS submissions. During these reviews, staff can examine whether each self-care and mobility item was observed, whether the entire 3-day observation window was covered, and whether the input from nurse aides, therapists, nurses, residents, or families was incorporated. The audit should also confirm that discrepancies between disciplines were addressed and resolved before the assessment was finalized.</p><p>The approach just described allows the facility to assign a percentage of compliance for each item, creating a set of key performance indicators (KPIs) to track over time. For example, instead of relying on anecdotal impressions (e.g., “our nurses’ aides aren’t documenting enough”), the facility can use concrete numbers that reveal whether compliance is trending up or down.</p><h3>Understanding the Source of the Issue</h3><p>Once data is collected, the QAPI committee must ask why errors or inconsistencies are occurring. In some cases, the root of the problem may be related to the process. Staff may not complete all episode documentation on each specific self-care or mobility task or they may not recognize that documentation is required throughout the 3-day window. In other situations, the issue relates to training. Staff may not understand the difference between specific tasks or the performance levels used for section GG. Sometimes the problem is inherent in the systems. For example, electronic health records (EHRs) may not provide sufficient prompts or fields for capturing required information, leaving staff to remember the details on their own. Finally, the culture of the facility may be a factor. Completing documentation and focusing on accuracy may be viewed as a siloed MDS issue, rather than a responsibility of the entire collaborative interdisciplinary team.</p><p>Root cause analysis (RCA) should be used to identify the primary cause of the issues identified. Whether through the Five Whys method or a fishbone diagram, facilities can begin to uncover the deeper reasons behind persistent noncompliance. Without identifying the root cause, any efforts to improve section GG documentation risk addressing symptoms rather than causes.</p><p>By applying RCA consistently, facilities can move beyond quick fixes and create sustainable improvements. For example, if training gaps are identified as the primary cause, the focus should be on the process or system used for training to ensure staff clearly understand performance levels and documentation expectations. If workflow barriers or EHR limitations are uncovered, processes can be redesigned or system prompts added to guide staff during the observation window. When the root cause is cultural, believing that section GG is solely the responsibility of the nurse assessment coordinators (NACs), leadership can emphasize the shared accountability of the interdisciplinary team, reinforcing that precise documentation reflects the resident’s true abilities. In each case, addressing the root cause leads to more accurate coding, stronger compliance, and ultimately better resident outcomes.</p><h3>Moving into Action</h3><p>When section GG issues are isolated or minor, the QAPI team may be able to address them through targeted feedback, training, or process adjustment. But if problems are systemic or persistent, it may require a formal Performance Improvement Project (PIP). A PIP provides structure, scope, and accountability, ensuring that the facility moves beyond merely identifying issues to actively solving them.</p><p>For example, if a facility discovers that dashes are used too frequently in GG0130 or GG0170 items, the QAPI team might charter a PIP with the goal of reducing dash use to less than 2 percent of MDS assessments within six months. The project might involve staff training on appropriate coding, daily check-ins during the 3-day assessment window to ensure observations are documented, and routine interdisciplinary reviews before MDS coding. Each step would be monitored through continued audits, with progress shared at QAPI meetings.</p><p>To be effective, the PIP must include measurable goals and a clear plan for monitoring progress. Assigning responsibility is also essential. The NAC, therapy staff, nurse aides, and charge nurses all may have distinct roles to play in the plan that the project should make clear.</p><h3>Sustaining Long Term Improvement</h3><p>Section GG documentation and coding issues are not a one-time effort. Without reinforcement, even well-executed improvement plans can lose momentum. To ensure long-term success, facilities need to include these practices in their daily routines. It could start with staff orientations, to create a positive culture and clear expectations for the importance of section GG documentation. Ongoing monitoring and education should be scheduled and not just hastily organized when problems arise.</p><p>Recognition is another powerful tool to improve a culture focused on accuracy for section GG. When staff meet or exceed compliance goals, celebrating those achievements helps reinforce positive behaviors and encourages a sense of ownership.</p><p>Most importantly, QAPI meetings should continue to review section GG compliance until results are consistently strong. Even then, it is wise to revisit section GG periodically to confirm that gains are maintained and to identify new opportunities for refinement. Facilities should also be prepared to adjust their benchmarks upward over time, fostering a culture of continuous improvement.<br></p><h3>Conclusion</h3><p><img src="/Articles/PublishingImages/740%20x%20740/JessieMcGill.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:175px;height:175px;" />Section GG documentation and coding are foundational to quality care and accurate reporting in nursing facilities. Yet they are also areas where many facilities stumble, whether through incomplete observations, missing documentation, or lack of interdisciplinary collaboration. By integrating section GG into the QAPI framework, facilities will gain tools to measure performance, identify root causes, implement targeted interventions, and sustain long-term improvement.<br><br><em>Jessie McGill, RN, BSN, RAC-MT, RAC-MTA, is senior curriculum development specialist at the American Association of Post-Acute Care Nursing (AAPACN).</em></p><p><em><br></em></p><p style="text-align:center;"><em><span></span></em></p><h4 style="text-align:left;"><em><span><em><img src="/SiteCollectionImages/logos/AAPACN.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;width:200px;height:56px;" /></em></span>The American Association of Post-Acute Care Nursing
(AAPACN) represents more than 17,000 long-term and post-acute nurses
and professionals working in more than 5,750 facilities through its
subsidiary associations, the American Association of Nurse Assessment
Coordination (AANAC) and the American Association of Directors of
Nursing Services (AADNS). Learn more at <a href="https://www.aapacn.org/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><span class="ms-rteThemeForeColor-2-0">AAPACN.org</span></a>.</em></h4><p></p> | 2025-10-21T04:00:00Z | <img alt="" height="739" src="/Articles/PublishingImages/2025/iStock-464806966.jpg" width="740" style="BORDER:0px solid;" /> | Quality Assurance and Performance Improvement;Quality | Jessie McGill, RN, BSN | Common issues are incomplete or missing observations, inconsistent input across disciplines, or the lack of an interdisciplinary effort to determine usual performance. The QAPI process is an effective method for facility teams to identify and address the root causes of these issues. |
| Assisted Living Providers Gain New Perspective of Dementia at NCAL Day | <p><img src="/Articles/PublishingImages/2025/NCALDay.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;width:200px;height:200px;" />Dementia care is at the heart of assisted living. That’s why this year’s National Center for Assisted Living (NCAL) Day attendees—a record of more than 300 assisted living professionals—lined up for the unique opportunity to learn more about what it is like to live with this diagnosis.</p><p>NCAL Day 2025 featured the Dementia Empathy Experience Program (DEEP), an interactive and immersive session that puts participants in the shoes of someone living with dementia. Through hands-on stations and expert-guided insights, they gained a deeper understanding of the cognitive, emotional, and sensory challenges residents face every day.</p><p>“Nearly half of residents in assisted living have Alzheimer’s Disease or other dementia,” said Pam Truscott, NCAL Director of Quality Improvement. “This exercise is meant to help providers better understand the challenges they face with even simple tasks—such as hanging up a jacket—and give them the understanding that empowers teams, strengthens care, and deepens their impact on residents’ lives.”</p><p><span><span><span><span><img src="/Articles/PublishingImages/2025/DEEP.jpg" alt="DEEP" class="ms-rtePosition-2" style="margin:5px;width:400px;height:205px;" /></span></span></span></span>DEEP was one of the multiple sessions offered throughout NCAL Day. The morning keynote speaker, Ralph Peterson, inspired attendees and shared strategies for attracting and retaining employees. Erin Thompson, the closing keynote speaker, helped attendees explore how to overcome common obstacles—mindset, boundaries, and energy mismanagement—to create vibrant, engaged, and purpose-driven communities. </p><p style="text-align:left;"> A multitude of other education sessions were offered throughout the day. Topics included proactive management strategies, technology and improving outcomes, the health and wellness director, population health strategies in assisted living, building trust through data, and value-based care and building networks.</p><p><span><img src="/Articles/PublishingImages/2025/fireside.jpg" alt="firseide chat with NCAL leaders" class="ms-rtePosition-1" style="margin:5px;width:350px;height:197px;" /></span>A highlight of the afternoon was the fireside chat on the future of assisted living. NCAL Executive Director LaShuan Bethea, Director of Policy and Regulatory Affairs Jill Schewe, NCAL’s Truscott, and NCAL Immediate Past Board Chair Gerald Hamilton discussed how the assisted living customer base is changing and how providers can change with it, identified opportunities to strengthen relationships and the impact on improving care, and highlighted how the demands of the profession have changed.</p><p><span><img src="/Articles/PublishingImages/2025/IMG_6688.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:250px;height:188px;" /></span>“There are so many facets of assisted living that are poised to change in the near future—from a growing population who will need our care to how we deliver it,” said Bethea. “I’m excited that we get to have this conversation and engage the providers who are on the front lines of the evolving profession.”</p><p>NCAL Day is an annual education and networking event for professionals in the assisted living industry and is held on the Sunday of Delivering Solutions, the American Health Care Association and National Center for Assisted Living (AHCA/NCAL) Convention and Expo. Visit <a href="https://www.ahcancal.org/Assisted-Living/Pages/default.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">www.ncal.org</a> to learn more about the National Center for Assisted Living. </p> | 2025-10-20T04:00:00Z | <img alt="NCAL Day 2025" src="/Articles/PublishingImages/2025/NCALDay.jpg" style="BORDER:0px solid;" /> | Assisted Living;Caregiving | Abigail Barreto | NCAL Day is an annual education and networking event for professionals in the assisted living industry and is held on the Sunday of Delivering Solutions, AHCA/NCAL Convention and Expo. |