In search of the missing acronym - nursing home accreditation and caring for the elderly

Nursing Homes, Sept, 1998 by Leslie E. Kolb

A Director of Nursing wades through today's longtermcarespeak to find the meaning of it all

HCFA, RAI, RAPs, MDS, PPS, RUG, JCAHO, CQI, LTC, SNF - this is the language of long-term care today. What does it all mean? What does it have to do with care of the elderly? And isn't there something missing? Recently I initiated a search to find out.

Let me start with who I am. I am Leslie E. Kolb, and I am an RN with a BSN who is the DON at Meadowbrook Manor, a SNF in Naperville, IL. I have worked in LTC for several years, working my way up from staff nurse. I should be very proud. What I am is overwhelmed. It seems that the more promotions one receives, the more acronyms one is obliged to know. To summarize my current knowledge:

As of June 22, HCFA has mandated that the MDS, which is a part of the RAI, will be electronically submitted so that the PPS can go into effect. The PPS will be calculated by RUGs under 44 categories, ranging in Illinois from RUC to CA1. It helps a facility to become JCAHO-accredited, but that can happen only if your CQI is in order. What's missing here?

We all know that HCFA (Health Care Financing Administration) regulates (and I do mean regulates) the financing of most of the care of the elderly. The RAI (Resident Assessment Instrument) consists of the MDS (Minimum Data Set), the RAPs (Resident Assessment Protocols) and care plans (which apparently don't deserve an acronym). The MDS will be submitted to the IDPH (the Illinois Department of Public Health, if you must know) to firm up the PPS (Prospective Payment System) and to compare resident care regionally and nationally. Although the PPS will use the 44 categories of RUGs (Resource Utilization Groupings) to develop reimbursement rates, the IDPH will only be using the top 26 categories ranging from RUC (Rehab Ultra-High) to CA1 (Clinically Complex, without depression), as well as a 27th category serving as a default for any assessment that is in error or late. All of this applies to SNFs (skilled nursing facilities, of course).

I still have this nagging feeling I am missing something.

Well, an optional but very desirable goal is to become accredited by JCAHO (the Joint Commission on the Accreditation of Healthcare Organizations). This is possible, however, only through a very thorough-going CQI (continuous quality improvement) program. It is useful to be able not only to recognize your weak areas, but to put a system in place to strengthen them and prevent recurrence. In no way do I disparage the importance of this.

Indeed, I don't make light of any of these acronyms. They all represent important concepts, and of course there are many more acronyms in today's health care equally deserving of respect. But there is one I don't see very often, at least not in describing long-term care, and I think I am getting close to remembering it.

I went to nursing school for a very simple reason: I wanted to care for the elderly. I treat each and every resident as if he or she were my own parent or grandparent, and I encourage my staff to do the same. There is an acronym that describes this - oh, yes, TLC (Tender Loving Care). I found it at last!

But then, just where does TLC fit in?

I know one thing: We will keep it in a prominent place on the abbreviations list we maintain at this facility. If we continue to do so, we'll be OK.

Leslie E. Kolb, RN, BSN, is director of nursing at Meadowbrook Manor, Naperville, IL. For further information, (630)355-0220, fax (630)305-6711.