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What does the new MDS mean for Administrators on 10/1/23?

The industry is buzzing… after pandemic-related delays, CMS finally released the draft Minimum Data Set (MDS) 3.0 version 1.18.11 for implementation on October 1, 2023, with the final version expected to be published before the new year. It’s been widely regarded as the largest change to the MDS in over a decade. With less than one year to prepare, a slew of changes that impact everything from interdisciplinary communication to assessments, and risk to both Medicare and Medicaid revenue, where should you start?

Let’s look at cause and effect. What are the most significant changes in the MDS 3.0 version 1.18.11 and what impact to skilled nursing facility (SNF) operations should administrators expect?

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Scapegoating and Aging

Researchers are aware of the detrimental effects of a practice called scapegoating. Many of us, during our life, have often played several roles that periodically we cast upon others. The aged parent, like it or not, often “inherits” one of these roles and becomes an unwitting scapegoat.

The researcher Archer suggests, “The focus of negative energy, arising out of scapegoating flows from a younger generation in the form of unfulfilled dreams, whereas the elder is the receiver or carrier of these multiple disappointments and worn traditions.” He further states, “The elderly individual tends to personify all of the facets of life that the young are conditioned to avoid i.e. death, illness, depression and uselessness.” It then becomes relatively easy for a young person to transfer their negativity and project it onto the aged parent in the form of an unwanted feeling, although the parent may in fact have already internalized the social rejection that is felt.

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Longevity and Aging – “A Good Life?”

In August of 2022, a Japanese woman by the name of Kane Tanaka died at the amazing age of 119, just two weeks shy of the biblical 120. When questioned at her 116th birthday what was her best diet for staying healthy and living a long life, her answer was simple, “I appreciate anything I eat.” When Mrs. Tanaka died she became the world’s oldest recorded person. She, in fact, lived seven years longer than the oldest American veteran of World War II.

The current average life span for a Japanese woman today is 87.7 years and 81.6 for a man. And the statistics continue growing! Government data reports that at present, Japan has the greatest number of centenarians (100 years plus) than any other country. As of August 2021 there were 86,000 individuals in Japan who have turned 100 in a country with a population of 125 million.

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Is The Grass Really Greener On The Other Side – Part II

In Part I of the question of whether the grass is really greener on the other side, we asked whether the grass is really greener with in house therapy. In Part II we want to look at whether the grass is greener with a contract therapy company.

Our company recently completed an RFP project for contract therapy services for a client.

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Is The Grass Really Greener On The Other Side – Part I

The phrase “is the grass really greener on the other side” is generally used to imply that things are not necessarily better on the other side. However, there are times when the “other side” may be better. The challenge is determining when the other side might be better, or are things on your side best for you.

In the world of skilled nursing this concept has been on the minds of many operators when looking at moving from a contract therapy relationship to an in house model. The shift to the Patient Driven Payment Model (PDPM) meant that therapy minutes would no longer be a primary driver of Medicare A reimbursement. The belief was this would lead to fewer minutes being delivered which in turn meant that it might be more cost effective to have an in house therapy program.

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Anxiety, Worry and Aging

According to the researcher Hogstel, “Anxiety is a diffuse feeling of panic, dread and lack of control that can be insufferable in its acute stages.” He further states, “Little is known about anxiety and its numerous manifestations even when it has not reached negative clinical proportions. It is a multi-response to helplessness, isolation, alienation and emotional insecurity. Evidence of anxiety in the elderly is often not as apparent as in younger clients.”

According to the research, “Anxiety is the motor that keeps people moving toward mastery of new and threatening situations.” The researchers Jarvik & Russell claim, “Anxiety runs with a soft, pleasurable purr that is not always perceptible. However, when it’s an extreme or prolonged personal stress, it is likely to initiate episodes of anxiety that is experienced as a noticeable jittering hum in the gastric area.”

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Stethoscope Maintenance & Care

For anyone working in the medical industry, you understand that the stethoscope is one of the most-utilized pieces of equipment. Because of this, it requires a diligent cleaning routine that can keep it clean from contaminants and germs, and will endure over the years to come.

So take a look at some of the tips below on how to care for and maintain your stethoscope.

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The Psychology of Impulse Buying

We’ve all been there–you’re walking through the mall and see something you just can’t live without, only to get home just hours later and immediately experience buyers remorse. But what if we told you there’s a scientific reasoning for why this occurs.

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California Summer Hiking Safety


Summertime in California means we’re headed outside to enjoy the fresh air and warmer temperatures that the season offers. Even still, you’ll want to make sure you’re well prepared before you head out on a hike to avoid a potentially dangerous situation. Take a look at some of the following tips to keep you safe from the California heat and wilderness this summer.

Stay Hydrated


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Volunteerism and Aging

Volunteer services provide an attractive role for many aged individuals. Interestingly, women have traditionally volunteered, but the greatest increase in volunteering has been among elderly men. The number of older women who volunteer has remained relatively constant.

Statistically, 35% of the 65 and older population are engaged in some type of volunteer work. Most of the work is with religious organizations. Those who are involved as volunteers feel they are contributing to their community and are filling gaps in services that otherwise might be unmet. Their self-esteem and usefulness appears to prevail. Here is a list of several programs that include senior volunteer opportunities:

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A new era in mental health care delivery



The COVID-19 pandemic fundamentally altered relationships and once-reliable life, work, school and home routines. More than ever, Americans have turned to virtual mental health programs during this time.

Before the pandemic, nearly one in five U.S. adults (47 million) reported having any mental illness. One in 10 adults reported symptoms of anxiety and/or depressive disorder. However, by July 2020, several months into the pandemic lockdown, a Kaiser Family Foundation Health Tracking Poll found that 41% of U.S. adults had reported symptoms.

With mental health care already being critical, the COVID-19 pandemic saw a surge in demand for services and pushed the need for optimal care, including effective digital solutions and virtual options for mental health care delivery into sharp focus.



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Stress Reduction and Aging

The aged frequently experience a decrease in their ability to cope with the multiple stressors of life that can result in a waning of their capacity to adapt. The following is a review of several themes that are recommended by the researchers and that offer practical suggestions for those who are dealing with the excessiveness of life’s stressors.

Theme I – Progressive Relaxation

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Member Spotlight

ACHCA highlights member, Sherri Gunasekera, LNHA, MHA, MSN, RN-BC, LNC, and her medication aide training workshops with facility RNs and AITs. Sherri teaches the only Medication Aide program in Southwest Ohio. Her training workshops instruct registered nurses and administrators-in-training on how to start their own Medication Aide programs in their facility.

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Pain, Comfort and Aging

By definition, “comfort is a state of ease and satisfaction, of bodily freedom from pain and anxiety.” According to recent research, “The absence of physical pain is not always sufficient to provide comfort. The aged may have their biologic needs satisfied but still be emotionally distressed.”

Nurses understand the significance of the word “comfort” which describes the goals and outcomes that aid in determining the nursing measures needed to administer care. However, the meaning remains vague and essentially abstract to the person who is the recipient of that nursing intervention. The researcher, Hamilton, studied the meaning and attributes of comfort from the point of view of the chronically ill elderly who is hospitalized in a geriatric setting. Hamilton’s definition of comfort is “multidimensional, and means many things to different people.” The researcher, McCaffery’s definition of pain is “whatever the person experiencing pain says it is.”

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Unwrap Winter Savings with Avis and Budget

In need of a winter escape? Make the experience safe and comfortable with deals from your ACHCA Avis and Budget Car Rental Savings Program. With the Pay Now feature, members can save up to 35% off base rates on every rental, plus receive additional offers like a free upgrade or dollars off.

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Proper Biking Posture

Riding a bike can be a fantastic way to spend your time actively, and achieving the correct posture will help you to increase speed, efficiency and reduce injuries. Experienced riders make it look easy to glide seamlessly across any surface, but doing so requires perfecting your posture and form. As you do the work to find the best riding position for your body, It’s important to keep in mind that there isn’t one cycling posture that works for everyone. Adapting guidelines and best practices to your riding style will help you find the correct posture for your body type.

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The Geriatric Orphan and Aging

The geriatric orphan is described as an elderly person with no close friends nor survivor or family members who are available to provide emotional support. He or she has had significant others and lost them to death, distance or fractured relationships. This individual has not, however, desired to be alone. The researcher, Boyack suggests, “It is imperative to establish a surrogate network, assist the individual through their grief, resolve any unfinished business and seek appropriate resources for maintenance in the community as long as desired and able.” However for some, it can be a welcome relief to be among others in a congregate or institutional setting despite a commonly held belief against residing in a nursing facility or setting.

As we observe this individual we begin to understand the three Rs that define the tasks of aging as identified by the researcher, Cynthia Kelly. They are “accepting reality, fulfilling responsibility, and exercising rights.”

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The Major Health Benefits of Cycling

Staying fit is synonymous with being healthy. Sports are the best way to ensure a more extended lifestyle and avoid serious diseases, like obesity, heart disease, mental illness, and many more. Also, it is enjoyable! Cycling has been touted as an amazing sport and outdoor activity with extensive health benefits. Out of many, these are some of the significant health benefits of cycling practice.

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Catastrophic Reactions and Aging

The researcher Goldstein, coined the term “catastrophic reaction” to describe the overreaction to minor stresses which occur in patients with advanced dementia. It is precipitated by fatigue, overstimulation, an inability to meet expectations, and persistent misinterpretations. According to Goldstein, “When the environment is misperceived and one feels threatened, the following signs are noted:

  • threatening gestures
  • striking out
  • increased voice volume
  • agitation
  • increased restlessness
  • hostility"


According to the researcher Mace, “Intervention becomes necessary to avert or minimize these reactions.” Any sudden deterioration in cognitive function with worsened behavior should be considered as a warning that the patient may be physically ill and will act out.

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Case Mix Strategies to Optimize Your Medicaid Revenue

Case Mix reimbursement operates on a weighted scale, the more resources needed to provide resident care, results in a higher CMI score and a higher reimbursement level. The Minimum Data Set (MDS) Assessment is used by states to collect objective data regarding a resident within specific timeframes, across multiple disciplines. When an MDS assessment is completed, a clinical score that reflects resident acuity is assigned. This clinical score, known as a Resource Utilization Group (RUG) level, correlates with direct care costs in a Case Mix reimbursement system.

Implementing systems that strengthen documentation of care provided and data capture in the MDS assessment, can have a significant impact on a provider’s Medicaid revenue.

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