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The Definite Guide to Outcome And Assessment Information Set

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Bob do you anticipate any changes with.Oasis yes stars most data sets tend to.evolve over time to meet changing.requirements and awaits this will really.be no exception we'll probably have to.make a few changes in 1999 for example.to accommodate the requirements of.prospective payment as we make those.changes will modify the Haven product.and will modify our training materials.accordingly.and the that's about it what I guess I.just want to say we all have to remain.flexible in the months a good word okay.thanks for next we're going to hear from.some providers who have gone through.implementing Oasis that's right that's.what we're going to do the we're going.to hear from from providers Bob whatever.you had is catching anyway that's what.we're going to do so let's take a look.hello I'm Kathy Crisler co-project.director of the Medicare quality.assurance and quality improvement.demonstration with me today are three.representatives of agencies that are.participating in the demonstration these.agencies have been collecting and.transmitting Oasis data since early 1996.I like them to introduce themselves and.tell us a little bit about their agency.my name is Tracy white I'm the quality.improvement coordinator at st. Mary's.home care in Grand Junction Colorado we.have about an annual census of around.1100 we're located on the western slope.of Colorado and we serve primarily rural.and an urban type of area I'm sue have.occur I'm director of regulatory affairs.with the Visiting Nurse Association in.Kansas City Missouri we do about a.hundred and fifty thousand visits a year.hi I'm Donna fallin font I'm director of.clinical management for Austin health.services for the San Luis Obispo branch.we're a free-standing agency on the.Central Coast of California following.from some of the points that dr. Shawn.has he made about keeping the big.picture of how Oasis relates to obqi.tell me a little bit about the value.Oasis and obqi to your agencies keeping.in mind you both your patient care and.sort of your overall quality improvement.activities so would you start off yes we.found that OSS being such an objective.assessment helped us in identifying the.patients who needed to be recertified.that was very helpful for our staff also.we found that the objective evaluation.of care provided that we did in our.process of care evaluations helped us.determine best practices and helped us.focus on what we needed to do to improve.our outcomes the beauty of the Oasis.data collection tool is that it allowed.nursing to assess the patient's overall.functional status in their home setting.and it gave justification for.incorporating other disciplines on the.case it promoted a more collaborative.effort between disciplines and improving.a patient's outcome when we did see the.overall outcomes as a result of the data.that we collected it gave us a really.true picture of how patients are.responding to home health care.interventions I think it can be.described in one word and that one word.would be invaluable.Oasis provides basically the basis for.outcome based quality improvement once.you have all that information you are.able to focus your attention for what.outcomes and what type of clinical.outcomes really need some intense work.to provide better patient care at the.point that you receive training in Oasis.data collection it was virtually an.unknown concept in fact the data set had.only been named oasis a few months.before you began what was the first.thing that you did after the training.what did you do when you went back to.your agency I think the first thing we.did was to eat chocolate and beg for.mercy.after the initial shock wore off we had.to make a decision about our assessment.forms and we had to decide if we wanted.to completely start from scratch or if.we wanted to kind of cut and paste to.include the Oasis data set when we got.to looking at our forms we found that we.had a lot.area for improvement within the entire.form what we did was essentially take an.eight-page fill-in-the-blank type of.assessment incorporate our oasis into.our comprehensive assessment and it.developed into about a 17 page format.the nurses were real concerned with that.number number of pages but it got into.more of a checkbox type of format.instead of a fill in the box format and.we found after the learning curve.happened and people were comfortable.with the form it actually shaved off.about 30 minutes of our documentation.time one thing we did was make a point.of showing the staff what forms they.would not have to complete and we laid.them all out so you don't have to do.this one anymore you don't have to do.this one anymore because that's all.incorporated into Oasis because it is a.lot of pages and it is overwhelming a.little bit to start with we also asked a.positive nurse as opposed to a negative.type personality to complete several.assessments using the new tool which.included Oasis and then report to the.staff when we did our training about.what our experiences were with it and.how she felt about it we also had the.supervisor of the team that was using.Oasis and the instructor of the class.complete Oasis on their own parents so.they would really have a good feel for.what the nurses would have to go through.and be able to give the nurses some tips.another thing we did is we did some of.our own computer programming to.integrate Oasis into our current program.to to help facilitate getting reports.and so on and I think that was very.useful also our agency did pretty much.the same we integrated our own agency.paperwork into the Oasis data collection.tool and then we asked to field our ends.and one physical therapist to pilot this.form for at least a month and they said.pretty much after six times that was the.magic number that they felt very.comfortable that it flowed it.you know it wasn't as overwhelming it.wasn't his time consuming it was very.familiar and a very helpful tool you.know in completing their assessments can.I ask whether when you did this.integration did you and after people try.to doubt did you come back and tweak it.a little bit did you make some minor.modifications or did you get it all.right the first time actually we're.still tweaking okay our first assessment.we found a little bit of area that.needed improvement and as regulations.changed as some of the Jayco standards.change we also find a need to tweak and.tweak it more tweak I can't it's a lot.of refinement and it's just I would've.thought by now we would have the perfect.piece of paper but we still don't the.interesting thing about Oasis amazingly.is that it is not a complete assessment.that we we did we did need to and.everyone else will find that they do.need to have other assessment items that.they're going to integrate with Oasis.and just this year we decided that we.did not have our pain assessment.adequately presented to the nurses on.the form so we did some little sticky.things on our form until we could get.the forms reprinted so it is it's an.ongoing tool the tool is actually.dynamic I don't think it's ever going to.be perfect and every agency has.different policies and different items.that they have to include on an.assessment besides the Oasis items.everyone is given feedback from you know.from our branch about what they'd like.to see change but once it was printed by.our corporation that's the way it stayed.since Oasis was so new when you employ.in a data collection I think we should.not sugarcoat all of this you had to.have encountered some resistance from.your staff let's just accept that as a.fact how did you deal with this and was.it successful and what other what tips.would you pass on to other people we.definitely were met with some resistance.from all disciplines documentation is a.big issue in home health and they they.viewed it as.more time consuming and taken away from.patient care but it was not an option.for our staff we were committed as as a.branch to carry on with this program so.there was no option they were required.to do this paperwork but we did do some.positive things we had a party in the.branch to kind of kick off the.implementation of Oasis and there was.ongoing instruction by our Quality.Assurance Manager one-on-one so as.people had problems they had somewhere.to go and and they were able to get.through it we found that we had.resistance from individuals rather than.the group as a whole and what we did was.let them express their frustration we.listened to them.tried to let them let it all out and but.then made it clear that it wasn't an.option that we were committed to this.and we were going to go ahead with it.the other thing we tried to do was make.Oasis or obqi or this whole project as.much fun as possible and I think all of.the agencies tried to do that too.we we had a theme and our theme was.Oasis is the basis and everywhere you.saw an I in that theme Oasis is the.basis we had a palm tree instead of an.eye and we were able to find some.swizzle sticks in the shape of a palm.tree and we gave those out as favors to.everybody who was participating we serve.food we had lunch for our program our.training program and we have found that.food helps anything at the VNA if we.have food everything everything goes.better we also offered continuing.education credit for part of the.training the part that covered just the.overall general view of what hicfa is.doing and what this project is and what.is an outcome and all of that kind of.thing we gave continuing education.credit for and then the rest of it when.we got down to how you fill out the.forms for our agency did not give.anybody credit and that was an.enticement to participate and come and.listen.many agencies are surprised by the.number of internal agency systems or.processes that are impact by the.implementation of Oasis data collection.what did your agencies experienced in.this regard we experienced an impact in.more areas of our agency than what we.originally thought we thought of course.that there was going to be impact in.medical records and the field staff and.the quality area just because of Oasis.but when we really get into it for the.long run and we start dealing with our.outcomes management we found it found.impact basically in our entire agency.even in those areas that we didn't.expect that Oasis would impact such as.in our accounts receivable or our.billing department just because we're.having to mail more and more forms to.insurance companies they want copies of.all those notes and the initial start of.assessment is very lengthy with the.Oasis questions in order to manage this.data we also found that we really didn't.need to add any additional staff we.found a lot of resources a lot of.shifting of job duties and we created.all of those resources within our agency.to manage Oasis and obqi.probably about the biggest addition of.resources is that our quality.coordinator or myself I was only.planning on working part time in order.to manage all of this I did have to move.up to full time but we don't believe.that Oh ace is the sole impact it was.all of the other regulations and changes.they're going on in the home care.industry I would have to say that our.medical records department was probably.impacted the most by this program.basically due to the sheer volume of.documentation that was coming through to.their office and they were trained to.perform the data entry and also to check.the tool and make sure that people had.had filled in every item and it became.very cumbersome so we actually added an.additional person to our department that.would be designated solely to this.program that person would be responsible.for tracking and entering all the data.that came through the branch.what can you share with others about the.data entry the data editing in the data.transmission aspects what issues did.this raise for you and your agency we.went through a lot of trial and error.for this specific process the first.thing that we started out with was that.we had one person reviewing the.documentation making sure that all of.the Oasis items were complete that they.made sense and then it went on to our.data entry for data submission or data.entry we then got this great idea that.maybe one person could handle this.entire thing and we moved that into our.data entry that she could review all.that documentation and decide if it.needed to be sent back to the nurse or.not or if she could go ahead and enter.that that specific process was a.nightmare we got about four months.behind in our data entry and data.submission from that point on in order.to get caught up.I was working until about two o'clock in.the morning and then decided that it.wasn't worth it we needed to change this.process the current process that we have.now is actually working very well I'm.reviewing the documentation for.completeness and then we have a process.and some flow sheets that move on to.data entry so that they know that all.documents are ready for data entry and.data transmission we've also.cross-trained all of our medical records.personnel to enter some of that data.entry so that it doesn't get behind.again I think Donna you said something.different about your agency about.whether you needed additional staff.ultimately we did decide to add an.additional person that would be.designated to entering the data doing.the edit and also responsible for the.transmission but medical records is.definitely a backup they are trained.also so that if that person is out it.you know the process continues it's.important to keep current our clinical.managers review documentation up front.also so we can catch it there before it.even goes to the data entry person so.there's very little for her to follow up.on she's she can actually just enter the.data.we found that we had to purchase a PC we.had a mainframe we weren't capable of.transmitting and so on so we had to.purchase a PC we also dedicated a data.entry operator to this particular.function dealing with oasis and the.transmission and so on and we also.noticed at one point we had a quality.problem data quality problem which.resulted from our NCR paper not lining.up well and what the nurse thought she.had circled the data entry operator.chose something or entered something.else so we had to really watch the NCR.paper if you were starting now what.would you do differently think about.this and maybe as being advice for other.agencies what would you change if we.were beginning today there were two.things I'd like to do differently one.would be that we would incorporate the.referral the intake referral into the.oasis assessment form and I would like.to see it generate a plan of treatment I.think that would streamline many.processes within our branch the other.thing is that we would definitely have a.specific process in place for accepting.the the data reviewing it tracking it.entering it and trends transmitting the.data the form itself is easily learned.documentation changes all the time this.form will change the staff adapt to it.and they can learn that easily.but the process within the office has to.be intact that needs to be set up before.you get started that's a good point on.of things we would start education and.training sooner and at all cost we would.avoid the Christmas holiday time we.would get more staff involved in.developing the form and in giving the.classes training other staff we did a.little bit of that but we would do that.even more so if we were had it to do.over again we would work at all cost to.avoid duplication.as you were saying the the the plan of.treatment and samosa sytems are.duplicate if we would work harder to.keep up the momentum and the enthusiasm.and we did the first time we would as.some of the agencies did have.newsletters have special reports special.bulletin boards or something like that.to keep up the momentum and the.enthusiasm I wish we would have had this.knowledge from day one I think probably.the one thing that if I could have done.differently I would have would have been.to incorporate larger teams from the.very beginning we had basically two.nurses that developed the entire.assessment forms an incorporation of.Oasis and that might have produced some.of the resistant that we also saw within.our agency when it came to training and.getting the field staff to support this.entire process I think a team of five.would be very good if we had the quality.coordinator there a physical therapist.and about three field staff of varying.specialties that might have helped.support the entire Oasis project and.outcome based quality improvement.project thanks Tracy.did each of your agencies have a.coordinator who led this led the.implementation effort and would you do.you think that was good do you think a.coordinator is a central component who's.a good candidate for that coordinator.position absolutely I think the person.who is in charge of managing quality is.a good person in our case I was the.coordinator along with the one of the.clinical supervisors we work together.very closely to make this whole thing.work out our branch originally began.this project with an actual Quality.Assurance Manager but unfortunately that.position was eliminated and delegated to.me but I didn't find it as cumbersome.because I had such a good.multidisciplinary project team that was.very helpful in our process of care.investigation and our monitoring.activities so it can be delegated to.one on administrative in administrative.staff but it can also be delegated to.somebody from the field with a quality.assurance interest I believe it is.important to have one person leaving an.oasis obqi implementation but the team.concept is also very useful you can get.people from different disciplines.different knowledge fields and different.perceptions in order to develop to.develop really good processes that work.I'd certainly like to thank the three of.you for participating today I think this.has been an excellent opportunity to.share some of your experiences with.other people who are just beginning the.process I think that again I want to.remind us all that we're looking at the.big picture that we're not looking at.simply a set of data items but we're.really looking at patient outcomes and.how patient outcomes can be used in our.agencies to monitor quality and to.improve quality over time that is.helpful as part of a comprehensive.assessment but it also helps us to look.at what it is that we're doing what.impact care is having on our patients.and then we can begin to to move forward.from there so thank you again for coming.Kathy does an assessment with Oasis.items require the clinician to collect a.lot of new or different information no.Doris the the information is part of any.agency's assessment in information right.now the only thing that Oasis means.that's different is that there is a lot.more specificity to the items so that.agencies will need to be sure that their.clinicians are prepared for the.increased specificity of the assessment.needed to answer the items all right.Thank You Kathy now as you can see we.now have been joined by new panel.members so let me introduce them to you.Mary st. Pierre director regulatory.affairs for the National Association of.homecare janice Stevenson health.insurance specialist clinical standards.group office of clinical standards and.quality.and we have Tracy mummer health.insurance specialist continuing care.providers branch Center for Medicaid and.state operations now our next.presentation by Mary st. Pierre will.include discussions on how a home health.agency should prepare for Oasis her.presentation will include startup.strategies comprehensive teens and.establishment of goals and timelines.how should home health agencies approach.implementation of Oasis implementation.of Oasis in-home health agency must be a.team endeavor that is approached.systematically the first steps in this.endeavor include establishment of a team.with administrative clinical and.clerical representation and.establishment of goals and timelines.administrative representatives who will.bring information about the agency's.mission resources and budget to the.effort clinical members should be.individuals who are adept in patient.assessment and who can provide insight.into the essential components of a good.clinical assessment tool skilled.clerical personnel are critical for the.efficient documentation of proceedings.and form changes and development of new.forms agencies that employ information.systems personnel should include a.representative from this area as well to.assist with data collection and.reporting aspects of Oasis.implementation before embarking on.adoption of Oasis each agency must.determine the financial and personnel.resources available for this undertaking.this information is critical for basic.decisions such as whether to incorporate.Oasis into the agency's current.assessment or to purchase a commercially.available assessment in which Isis has.been integrated whether to hire.personnel for data entry or to contract.with an outside service once budgetary.resources limitations are identified a.strategic plan defining goals and target.dates must be established the plan.should address all aspects of regulatory.requirements.to ensure that your agency will be in.compliance with Oasis data collection.recording and reporting requirements the.plan must encompass implementation.strategies and staff training after the.team is identified scheduled work.sessions should begin and specific.timelines identified for each phase of.the project it is essential that every.session be goal-oriented to ensure that.the final products a comprehensive.assessment tool with Oasis data items.and a plan for Oasis data reporting are.completed in time to meet the.implementation dates required by the.regulations once your agency has.completed work on adopting an oasis.assessment format it must be pilot.tested pilot testing is critical to.ensure that the tool is right for your.agency the tool must not result in.documentation burden must be.comprehensive and must be an effective.assessment tool for your agency's.patient population if the need for.change is identified modifications need.to be made before finalizing the form.and training personnel when final.modifications have been completed forms.can be printed when making decisions.about printing options considerations.should be given to future modifications.that may be required to the Oasis data.items once the PPS case-mix them in.frustration project is completed next.year staff training is the most.important activity and implementation of.Oasis training should actually be.started at the time the Oasis team is.established all staff should be informed.as to Rio ASIS must be adopted in your.agency they should be informed of.regulatory requirements and the role and.benefits of Oasis in patient care and.ways to improve patient and agency.outcomes staff should be kept informed.of progress as the tool is being.developed once the comprehensive.assessment tool with Oasis has been.developed tested and modified.formal training sessions should be.planned for all clinical staff training.will require at a minimum one for our.comprehensive program with a shorter.session at a later date to address.problems and questions some clinical.staff may need individual follow-up if.problems are identified well Mary where.can an agency purchase patient.assessment tools that meet the Oasis.requirement there's an addition to Oasis.being available on the hicfa website and.eventually the electronic version of.Oasis in the form of Haven there are a.number of vendors that actually sell the.Oasis tool and we anticipate once.electronic specifications are completed.that they will also have the electronic.versions all right thank you Mary well.is the Oasis data set intended to be a.complete comprehensive assessment that's.a question that will be discussed by our.next presenter home health agencies are.required to integrate the Oasis data set.into its own assessment process for.clarity the Oasis data set is not.intended to constitute a complete.comprehensive assessment rather the.incorporation of the core standard.assessment data set will complement the.home health agencies current approach to.comprehensive assessment all Oh a.Sustaita items were developed for.outcome measurement risk adjustment or.patient identifiers Oasis data items.address demographics and patient history.living arrangements supportive.assistance sensory status integumentary.status respiratory status elimination.status neuro emotional behavioral status.activities of daily living medications.equipment management emergent care and.discharge information the Oasis data set.does not include an assessment of vital.signs which are a common part of a.patient's assessment for this reason.home health agencies must integrate the.Oasis items to comprehensively assess.the health status and care needs of.patients most Oasis items require the.same inform a.that the majority of care providers.currently gather inpatient assessments.but the Oasis requires the information.on a more precise scale for example many.care providers assess each patient's.ability to bathe using only three levels.Oasis uses greater precision which.results in items that are more.descriptive for clinical purposes and.items that are more reliable and valid.this statistically improves their.utility in an outcomes database.environment in this way all approved.agencies will be collecting information.using precisely the same items to.ultimately measure and risk adjust.outcomes to incorporate the Oasis data.set the agency should review its current.clinical documentation and compare.assessment items with similar Oasis data.items next the agency would determine.whether to adapt its current form using.a cut and paste approach or develop an.entirely new form home health agency.assessment items plus Oasis items equal.the integrated assessment for example.under the activities of daily living in.assessing a patient's ability to bathe.an agency may note only the following.three levels independent needs moderate.assistance or dependent the Oasis.dataset evaluates a patient's ability to.bathe on a more precise 6 level scale.this information is provided in your.packet in this example all of the home.health agencies assessment questions are.indicated in the Oasis by replacing the.more precise Oasis data item mo 670 on.bathing for its assessment the agency.may eliminate its assessment questions.in this area altogether in many.instances all of the home health.agencies assessment items will be.replaced by Oasis data items this.results in a more streamline assessment.Janice in your presentation you talked.about integrating Oasis how must the.Oasis be integrated the Oasis can be.integrated within the agency's own.assessment in any order to meet the.individual needs of the agency however.we don't recommend it because of the.Skip patterns within the groupings it.could decrease the efficiency of the.encoding process okay thank you our last.presentation will answer questions on.how a home health agency should approach.implementing Oasis and data collection.but before we hear that presentation let.me remind our viewers to complete the.participant reaction sheet in the back.of your handout package and then turn.them into your site coordinator the site.coordinator should fax the participant.reaction sheets and/or the final.downlink information sheet to barbara.Massenburg and here's the fax number.area code for one zero seven eight six.one zero zero eight now following this.session we'll also have a 15-minute.phone in session the number for calling.in your questions is one eight hundred.nine five three two two three three and.the fax number if you're too shy to call.you can fax the numbers for 107 eight.six one four two four now let's return.to our next presentation.let's review what you will need for.Oasis data collection and reporting if.you already have a computer system in.your home health agency you may have.already made a mental assessment of how.it stacks up to the requirements that.Bob Gould Rick mentioned earlier if you.do not already have a computer system or.simply wish to upgrade your existing.system to one that will more efficiently.report Oasis data we recommend that you.consider using the following.configuration shown here on the screen.we recommend a Pentium processor with.Windows 95 or Windows NT with 32.megabytes of RAM a 2 gigabyte hard drive.a cd-rom drive and a fast modem we.recommend a 56 kbps modem.we also recommend a color monitor access.to the internet web browser software and.last but not least a printer this is a.review of what you were shown before as.a recommended computer configuration.bear in mind that a system with less.capacity than the one recommended may.work but it may not work as efficiently.as you would like all home health.agencies should have a computer with a.modem for electronically transmitting.Oasis data as well as a web browser like.Netscape which provides the home health.agency with the necessary functions to.transmit Oasis data to the state you.should also have internet access if you.want to be able to download information.from the hicfa website as an option a.home health agency may wish to contract.with the data entry service that will.take care of data entering and reporting.Oasis information this is perfectly.acceptable but remember the home health.agency is still ultimately responsible.for meeting the reporting requirements.as well as maintaining patient.confidentiality.if you decide to contract with the data.entry service be sure to address.confidentiality of patient information.in your contract.with regard to software home health.agencies have the option of developing.their own or purchasing data collection.software that can be used to support the.Oasis reporting requirements as well as.other clinical or operational needs such.as care planning.Quality Assurance or billing however as.mentioned earlier hicfa is developing.software to accommodate oasis data entry.and transmission called Haven Haven will.be available for downloading off of the.hicfa website at no charge in lieu of.downloading the Haven software hicfa.also plans to make a cd-rom version.available if you plan to use the Haven.software remember you will need to have.internet access or a computer with a.cd-rom drive in order to obtain and.install the software on your system we.expect Haven to be available for general.use sometime in the fall Haven will.allow you to collect Oasis assessments.in a database and transmit those.assessments in a standard format to the.state software vendors are welcome to.use Haven as a core program for.developing their own software that.supports the Oasis reporting requirement.while also supporting other agency needs.we realize that home health agency staff.will require training on encoding which.means entering Oasis data into the.computer and compiling Oasis data for.electronic submission to the state at.least one person in each home health.agency should be trained in data entry.and data transmission procedures we.expect that the state will provide.training to familiarize home health.agencies with the steps for startup.initial transmissions phone numbers.passwords the Haven software and.feedback reports hicfa is currently in.the process of training the states for.this function home health agencies have.flexibility in choosing a method to.encode their Oasis data but that method.must comply with requirements for.safeguarding the confidentiality of.patient records for instance.after it's collected data can be entered.directly by a clinical staff member.using a laptop computer or by a.technical or clerical staff member from.a paper document as long as it's been.completed by a clinical staff member or.by a data entry operator under contract.to the home health agency to Cillian.oasis data as mentioned before finally.on at least a monthly basis agencies.must transmit all their Oasis datasets.completed in the previous month to the.state you are invited to do this more.often.but monthly is the minimum requirement.the regulations on collection and.reporting of Oasis data will provide you.with additional written information on.the topics presented here today when.they are published in addition home.health agencies will have lots of access.to help in implementing Oasis.requirements through such things as.telephone hotlines detailed instruction.manuals state and hicfa personnel and.don't forget our hicfa website let's.take a look at that address again.thank you for taking the time today to.familiarize yourself with the Oasis.project a Tracy you mentioned that if.home health agencies contract with the.data-entry service for data entering and.reporting Oasis information to make sure.they address the patient confidentiality.in the contract what did you mean by.that.thanks Doris under the new regulations.when they're published home health.agencies and their contractors will need.to maintain confidentiality of the.patient's medical record that means that.Oasis information should not be released.if its patient identifiable for any.reason other than for what it was.intended if a home health agency chooses.to contract with a data entry service.which they certainly can the contractor.must also maintain that same patient.confidentiality.in the contract between the home health.agency and the contractor there should.be some language that speaks to this.confidentiality issue thanks Tracy.before we conclude today's broadcast.we'd like to provide you with a final.opportunity to call in or fax in your.questions the telephone number is.1-800-321-8633.okay question politics are received any.information from Joint Commission on.using Oasis to meet the aurochs.requirements okay we're gonna step over.to the microphone this is Mary Vienna as.some of you may know the Oasis data set.those data items are acceptable to the.Joint Commission for purposes of meeting.the aurochs requirements be updated and.transmitted with each new diagnosis in a.given bill month for example if the.starting care is one month with one.diagnosis then ten days later there's a.new diagnosis and then is that a Mary.Vienna question again sure the.collection of the Oasis information is.tied to the length of time that patients.being seen by the home health agency.excuse me not the diagnosis so that if.you had a start of care date and the.patient said hey said had diabetes and.they developed a stroke during the time.a mini-stroke during the time they were.being seen by the agency you would not.redo the restart the clock for the Oasis.based on that new diagnosis you might.collect the Oasis information because.it's it's a significant change in the.patient's status but it does not have to.be collected every time the patient has.a new diagnosis does that Bob word well.step up to the mic well it's it because.the system is really just under.development at the present time it's a.little bit premature to talk about the.criteria all the Oasis items that.currently exist plus the Oasis Plus.items are being utilized even even as we.speak by research agencies.the results of that should be coming out.within the next few months at least in a.preliminary form at that time we'll have.our first inkling in terms of what items.will be correlated with enough resources.to predict utilization and by predicting.utilization we're able to okay very.vienna back to the microphone or janice.the home health conditions of.participation apply to all patients.served by the agency so we would expect.that Oasis be collected on all patients.with the exceptions that I mentioned.previously okay any more questions.Melinda let's take another call from.Margo who is calling from Maryland and I.just want to let you know we have.extended the time of our broadcast until.4:00 p.m. Eastern Standard Time so.you'll have plenty of time to get your.questions answered Janice if we add the.Oasis items to the assessment won't the.Oasis make an agency's assessment.process long and drawn-out.yes it will that's the reason we say.that in doing a side-by-side looking at.their own assessment items looking at.the Oasis items the items are integrated.and the agency would replace the their.own assessment items with the Oasis.items that's what makes the ouais that's.what makes the assessment integrated.okay let's take another telephone call.we have Madadi from tennessee calling.please go ahead Betty hello hi is this.Betty yes I have a question again.regarding the patient population that is.affected by Oasis in my home health.agency owned a home infusion therapy.division and a private-duty division.that provides home health are not home.personal care support services in.private duty nursing in the home with.those patient.also have to have Oasis collected on.them the conditions of participation.applied to the Medicare certified home.health agency so if the agency had.another company providing DME or other.kinds of lines of business the Oasis in.requirement would not apply to them as a.matter of fact it would be inappropriate.to collect Oasis information for a large.subset of populations another example.mentioned previously was hospices if.home health agency has a hospice Oasis.would not apply to those patients either.all right Thank You Michelle for your.call let's take our next call from Nate.who's calling from Baltimore because I.have a question regarding the.interaction between Oasis and.reimbursement rates and specifically.regarding possibility of Oasis creep in.8h a similar to what we experienced and.the yardie creep in hospitals what's the.plan to prevent it but I think I think.it's a fair assumption to that there may.be some Oasis creep just as there's been.DRG creep in hospitals there's no real.way that you can hope to prevent it I.think that the best thing you can do is.hope to adjust to it the PPS system that.we come out with you know October 1st.1999 is not going to be the the.prospective payment system for all time.I'm sure that this is going to be a work.in progress and these weights will have.to be adjusted with time if in fact we.do experience a creep okay someone else.in the audience hi this is Karen from.Maryland can Haven produce reports Bob.holder yes that question was raised.earlier too so I'll address that it yes.Haven can and it depends on the type of.report when a batch or our file is.submitted to the state system you'll get.an immediate report on what's been.accepted what's been rejected with what.we call a fatal error and what's been.accepted but has some problems and those.will be identified Haven will also.produce certain pre-programmed reports.that'll give you like patient rosters.and reports on the assessments submitted.to the system eventually when we get.enough.six months or years worth of data Haven.will also produce quality indicated.reports and you can access those someone.earlier asked when would they be.available the the ones on the batches.you'll get immediately the others are.available on-demand you can just log on.to the state system and get them at that.time I guess I'm asking about reports.that analyze the data and can be used.for quality improvement the quality.indicator types of reports yeah yes.those are the ones that Haven will.produce but you won't get them out of.the very first batch of Haven Haven is.basically a data entry tool it's the.state system and maybe I should have.been clear about that that will produce.the reports and that you will get via.logging on to the state system Haven.itself will maintain a database within.your agency that you can look at but it.doesn't have built-in reports of the.quality indicator type I have one more.question so um the software companies.are I guess besieging us with.information and offering all these all.kinds of great things one of the things.they're talking about is scanning the.Oasis form instead of having a data.entry person can you respond to that oh.that's that's a capability that's out.there again we rep we talked about Haven.in terms of one alternative I think what.you want to do is have those people in.evaluate what they're doing don't sign.any contracts and until you've seen a.test of what they're doing and make sure.it meets your needs there are lots of.capabilities and lots of vendors that'll.be in this business did you want to make.sure that they're meeting your needs.Karen we have one more question here.from the room mrs. Linda from Baltimore.I have a question for Tracy regarding.Medicaid.I think Marian Vienna had mentioned.before that there are there are.situations where Medicaid only agencies.might be excluded because of waivers.it's the two-part question first of all.the Medicaid data that will be collected.from some of the agencies well the same.type of analyses be performed for them.and secondly is there any communication.encouraging the Medicaid agencies to.participate voluntarily Tracy I don't.think I have any answer for that.does anybody have any anybody from our.distinguished panel well you know what.we may not have an answer right now but.when you put that up on the website put.that question up you'll get your answer.okay Linda.I have one more question this is already.from the Maryland site we're gonna run.around here alright I wondered if there.has been a date set yet for the use of.final regulations to be released there's.a lot of talk about when they might be.coming out and I know originally they.were scheduled for June or July so I'm.wondering if that timeframe has has been.set okay Mary it's difficult.prognosticating when a regulation is.going to come out since there's a.multiple levels of review of a.regulation all I can say is that we.expect the regulation to be published.shortly okay all right thank you all of.you from Baltimore.we have Susan on the line from Florida.thank you for waiting Susan please go.ahead with your question.thank you we have three questions.there's a great questions for Bob okay.which one and the question is on the.pizza website it says that you we can.download the files from Adobe Acrobat.the PDF format is that available in any.other word processing format Bob Calder.hello yeah hold on a second we were.deciding which Bob that was it's this.Bob and I think the answer is no that's.the way they're available right now I.think maybe I should mention one thing.early that someone asked earlier which.is when will Haven be available might be.good to mention it now and the version.that we'll put out on the hikmah website.will be available October 31st if an.agency were to request a cd-rom version.of it won't be available for a week or.two after that because it takes time to.press the CDs and Melanie have a couple.more questions all right go ahead.hi this is Susan Otto from Florida do.you have to complete a resumption of.care for patients who go into the.hospital for 23 hours days or for an.outpatient procedure okay Mary weakly.the patient goes into the hospital it's.going to be in the hospital for 24 hours.or more you'll need to complete a.resumption of care stay only if that.stay was for non laboratory testing.diagnostic testing okay thank you Kevin.also when there are multiple disciplines.on a case do all the disciplines have to.complete the assessment assessment upon.the resumption of care or at discharge.or who is primarily responsible for that.okay go ahead okay typically the.typically you have more nurses in a home.health agency than other other specialty.types so the nurse can complete that you.don't need to have all the different.disciplines complete parts of it.although you could do that if you chose.to you could have one person do that.okay thank you all right and I just want.to notice I wanted to add to that from.the standpoint I think it's important to.realize that what you are going to be.receiving is a report that talks about.the outcomes of care for your agency.think about that patient as a patient of.the agency and therefore you need to.look at start of care and at sixty day.intervals and at discharge from your.agency so whoever is providing care I.think it's important to say this is my.agency's patients and I'm going to look.at data collection comprehensive.assessment and Oasis data collection as.it reflects what the patient's status is.in my agency okay thank you Kathy and.thank you all from Florida let's take a.call now from Cleveland it's Michelle on.the line.that implementation of oasis in the lake.is labor-intensive even with the.minimalist mentality can anyone tell us.if there's going to be any reimbursement.or financial compensation for the effort.turn down your volume Michelle we're.getting you an answer my Oasis costs are.you know within reason our allowable.costs on your cost report so in the in.the context of cost reimbursement there.isn't there is not an issue with being.an allowable cost of course the.difficulty is that under the current.cost limits many agencies are at their.cost limits and because they're at the.cost limits even though the costs are.allowable they may not be recognized in.the regulation that we just published.this month on the 11th we indicated with.regard to the per visit limits we have.some flexibility there's a in there for.some additional cost for Oasis.collection we also ask for comments.regarding other kinds of costs that.agencies will be experiencing.particularly real data on what costs.they'll experience in Oasis with the.idea that in responded those comments.there might be a way to raise the raise.the limit more if they're actually more.cost that agencies will be experiencing.the the frustrating part of this of.course is we're talking only in terms of.raised in the limits with regard to per.visit limits the preventive Fishery.limit which in many cases is viewed as.more stringent is so set in the statute.as an absolute amount of money when.absolute base year amount that we don't.have flexibility under the current law.to change that there are certainly some.interest I understand in Congress not.only in changing the interim payment.system but in terms of of perhaps.changing the to for me to allow that.limit to be raised to accommodate some.Oasis cost we'll just have to wait and.see on that one.Tracy let me ask you this question Mary.Vienna mentioned using Oasis in a.chronological order but didn't say if it.will be required or not the Oasis.webpage says it will not is is still.true that's a question that's been.popular in the past few months and I.guess the old adage if we knew then what.you know now would apply we have gone.back and forth with this issue now that.we've had a chance to look at the at.least the initial phases of the Haven.software we realized that it wasn't.necessary to require home health.agencies to incorporate the Oasis data.items in sequential order as they're.presented on the form however let me.just say that we don't recommend that.you put them in out of order it may it.may slow down the process of actually.entering that data into the Haven system.ok Thank You Tracy.let's take a telephone call quickly we.have Miss Rose I guess from Minnesota :.yes I'm here hi go ahead I have five.questions the first one if it's an.agency provides services in two states.well they have to submit the data to one.or two states okay so that's the first.question who's going to take that go.ahead an agency has has patient has.branches in two states the branch will.be needing to send the data to the.parent agency who will send it to the.state where they have their license to.the one state okay so you'll send it to.the state that you have your license in.yes okay what if you're licensed in both.states you're housed in one state but.licensed in both states I think I'm.going to have to get some clarification.from my pan of experts and we'll have.this on the webpage.okay thank you the second question can.state home Health Association's send.representatives to the hicfa sponsored.educational sessions actually I can I'd.be glad to take that the plan right now.hicfa.is sponsoring an educational training.program and it is in two phases phase.one is the end of August and the.beginning of September at that phase.the training will be only for state.surveyors after that they'll be phase.two and phase two will be held in.October hicfa has invited the state.associations to designate a.representative for their states to.participate in that training in October.and we do have some dates for that we.will make those dates available.hopefully by the end of today to the.state associations okay any questions at.the third question what are the.timelines for completing the discharge.data set good question the discharge.data set is going to be it will need to.be complete within 48 hours after.knowledge of the discharge date thank.you.the fourth question Mary earlier in the.conference encouraged agencies to.highlight pilot their new forms after.the final rule will agencies be able to.collect Oasis on only a pilot group of.clients versus their entire Medicare.certified population I'd suggest you.start doing your piloting your piloting.sooner then after the Reg is published.once the Reg is published there will be.some effective dates and those dates.won't be available for piloting testing.so you might want to think about doing.your testing piloting testing no sooner.okay we have one more question.the final question Hicks have created.the comprehensive assessment form for.the MDS why are the form creation cost.being shifted to the home care provider.for Oasis.we're thinking about that one and I.think Cathy's gonna I think that what.you're asking is why if I can rephrase.it.why didn't hicfa develop a comprehensive.assessment instrument and just hand it.out to the to the agencies I can tell.you that the reason I was actually on a.work group that was involved in making a.decision as to whether that was the way.to go that work group had.representatives of all the home care.associations every discipline that.provides home care and was actually.convened by hicfa probably in about 1995.that decision the decision of that.particular work group was not to do that.that they felt that each individual home.care agency was able to identify the.essential components of a comprehensive.assessment and therefore that workgroup.said no hicfa do not develop a.comprehensive assessment instrument for.all of the multitude of populations that.a home care agency might serve and.mandate that particular instrument so I.believe that that decision had a good.bit to do with the decision to move.forward with requiring a comprehensive.assessment only a core group of specific.data items which were which would be.required.how about Mary we can come back to the.microphone I have another question for.you.does Oasis have to be done at time of.recertification oh there is a follow up.Oh ASA swatch you have completed your.start of care assessment at the.timeframe 57 to 62 days after the start.of care which coincides with the recert.time that's when you would complete a.follow-up assessment okay thank you.Marian from Minnesota we hope to get a.question from you but while we're.waiting for you to call us back we're.gonna take a question from Peggy who's.calling us from Arizona please go ahead.and Peggy hello hi this is Peggy from.Arizona and I would like to have someone.in that group define health services and.personal care that are the exceptions.for not using Oasis now if you don't.have specific definitions we would be.happy if you'd put it on a website we're.gonna put it on the website because you.asked so nicely okay thank you did you.have another question while you're there.yes go ahead.oh I guess she doesn't she got down sit.oh okay that well wait I've got now.they're answered question well go ahead.you have since the revised CEO peas will.not be published for at least another.year.how will you incorporate the five.standards of comprehensive assessment.requirements with the Oasis could you.Peggy could you repeat that question.again please since the revised CEO peas.will not be published for another year.how will you incorporate the five.standards of the comprehensive.assessment requirements was that not in.the revised CEO piece Traci.let me just rephrase that let me just.give you a little bit of background on.what is actually being published last.year in March the proposed conditions of.participation for home health agencies.were published right now at this time.we've separated out only a piece of.those proposed regulations and we're.planning to publish that as a final.regulation and that would be the.comprehensive assessment piece so just.that piece out of the many other.conditions that were proposed last year.will be published in addition to that.and along with it at the same time will.be the reporting requirement that goes.along with collecting the Oasis data.does that answer your question okay let.me add that the remaining conditions of.participation will be published shortly.after that are we expecting to publish.them short shortly after that okay.is that all Peggy all right then let's.take another call we have Virgie on the.line from North Carolina thanks for.calling Virgie.thank you turn your volume down okay.first question is and this is a.follow-up question to the reassessment.Serbia that has to be done every 57 to.62 days there has been some confusion.whether this needs to be done in.conjunction with a visit and if yes if.the physicians ordered frequency falls.outside of the 57 to 62 days.will we be reimbursed for the visit or.and does the visit have to be done.within the 57 to 62 days Mary see follow.our visit will need to be done within 57.to 62 days and it has to be company by a.visit to the patient's home environment.I can't address the reimbursement issues.at this time so we'll have to add that.to the website okay I have another.question is the Haven software year 2000.compliant.absolutely absolutely I'll tell you a.couple more things about the software.since your kindly yes and I had my cheat.sheet with me anyway you'll notice on.the web page that there are draft edit.specs for the software for for Oasis the.draft edit specs and the draft forum.Oasis b1 698 698 are essentially not.going to change materially before.publication we had kept the draft up.there in case there was some maneuvering.within hicfa as it went through the.processes of getting toward publication.but we we have some minor changes that.we are going to post next week on the.website so you will see a new version of.the Oasis b1 898 and we'll pull the old.one off the website whenever we have a.change we will post that as soon as.possible on the website and a note to.software vendors if you're waiting until.publication of the Reg please don't.please use the draft data specs that are.on the web we will have a couple minor.tweaking changes that we're going to.post next week so please get.if you plan on using the software for.for your business a couple of other.things on the about the form we've added.a couple things that you didn't have on.the oasis B form one thing is we put a.patient's on first name mill name and a.surname if they had that we've moved.gender from the from part the body of.the form into the demographics such.section we have a few notes notice all.the years for all the dates the year is.a four-digit field so we're compliant.with 2000 and there's a new change in.the race ethnicity listings we have.adopted the recommendation of OMB they.had a review panel for race and ethnic.standards several years ago and they.have adopted the new five.classifications that we have used on the.form so we're in compliance with with.with OMB and this is the same listings.that they'll be using on the 2000 census.I think does that answer all your.questions.okay birch is gone well I have a little.housekeeping duty here if you would.please send your evaluations to the fax.number that I'm going to give you and.it's going to come up on your screen the.fax number is four one zero seven eight.six one zero zero eight that's four one.zero seven eight six one zero zero eight.please fax your evaluations there I.believe we have steam holding on the.line from Tennessee Steve are you still.there yes go ahead with your question.thanks for waiting.for the agencies who've been using Oasis.for a while how have you found this to.impact both productivity and clinical.quality care.some Kathy's Kathy yeah I think I can.address it from the standpoint of the.demonstration 8 the agencies that have.been participating in both the national.and the New York State demonstrations I.can think I can say without exception.that all of them experienced a drop in.productivity while their clinicians were.first learning what the Oasis items and.the amount of specificity that was.involved however I think also they have.for the most part experienced that.returning back to what it was pre Oasis.implementation I think there are two.large variables always to keep in mind.when you are talking about the impacts.of Oasis on data collection in your.agency one variable is whether your.clinicians are accustomed to doing a.comprehensive assessment currently and.the other variable has to do with.probably whether they are experienced in.home care or relatively new to home care.and each agency needs to answer that.question themselves individually if your.agency is accustomed to doing a.comprehensive assessment at the present.time then the Oasis learning curve is.probably in the range of four to six.assessments I think is one of the.providers indicated on that particular.section of the videotape and you will.see after that period of time that their.productivity is back to what it was.before.okay Steve thanks for your question.let's take a call from Kathy she's.calling from Cleveland please go ahead.Kathy my question is related to the fact.that you have seven days to encode edit.and lock which was included on our.outline am i understanding that that.means once the staff has completed the.Oasis information we then have seven.days to perform the data entry edit the.data entry that we've done and lock it.and then we can transmit it any time.within the next month is that a correct.understanding yes it is you're right.you'll have seven days to enter the data.if you have any Corrections any.omissions your debt entry staff will.contact the clinician to find out the.correct answer.there will be edit specs if there's a.change they will contact the clinician.to make sure they have the correct.information and then they can lock it.and they can transmit that to the state.agency anytime they'd like to if they.want to do it on a monthly basis they.can do that if they want to transmit it.more frequently than monthly they can do.that okay any other questions Kathy yes.actually you hadn't mentioned before.that you had a - I thought I understood.you had a choice to not integrate the.form but if that you were using your.assessment and the Oasis in separate.actual instruments during the assessment.visit that you would need to eliminate.any information on your assessment.instrument that was also included in the.Oasis is that correct yes that's correct.okay Janice yes you you are to look at.the two forms your form in the Oasis and.anything that is on the Oasis that also.appears on your assessment you remove.your items in other words you you.replace your items with the Oasis item.okay Kathy thank you so much let's take.another call we are a small to medium.sized agency that does over 90 percent.of our cases in extended hours visit.cases that are 24 hour for the most part.dependent patients with degenerative.disorders and basically for outcome you.know what we judge is if we're going to.be able to minimize their.hospitalizations and keep them.maintained at the current level they're.at with preventing further contraction.how does the ASIS affect us all right.who's going to take that Kathy Mary.Vienna had to leave and and I think left.me in charge of that and I hope I.answered this correct this question.correctly I think again if you are a.certified agency Mary said that the the.Oasis data collection was required for.all patients of the certified agency if.you're asking whether the outcome.measures that are possible to compute.from Oasis would apply.to those patients who are part of your.agency I can tell you that the answer to.that question is yes because there are.many patients like yours in other.agencies across the country where in.essence the purpose of your care is.really to make sure that that patient.conditions stabilizes and indeed that.some of the outcome measures that are.computed from the Oasis do indeed look.at the stabilization of for example.functional ability okay thank you very.much for your question.just one quick reminder again before our.program is over we'd ask you to send.your evaluations to us by fax and that.number again is four one zero seven.eight six one zero zero eight we have.jock Abed calling from Maryland please.go ahead talk about with your question.yes I I need to hear a gain about the.60-day research between 57 days and 62.days if you have patients and you're.visiting once a month should you plan to.see that patient when it's time to.research you plan to see that patient.within maybe 25 days so that you could.be within the 62 days it is important to.plan the visit schedule accordingly so.that that visit does indeed fall within.the 57 to 62 day timeframe we have found.that many agencies most agencies really.are able to do this and to associate.that data collection that assessment.data collection with the recertification.in fact I am a great advocate of.integrating the Oasis data collection.into all of the other components that.are required for your agency not to make.it something that's separate but rather.to may.get part of your routine in terms of.care delivery and this is exactly what.we have seen agencies do they have whoa.they have made sure that they have a.visit timed between that day 57 and day.62 of the certification period they have.used the patient's status at that.particular time as the basis for the.recertification or if no recertification.is indicated then that Oasis data.collection actually becomes the.discharge assessment for that patient.much talked about for your question.just a reminder to the callers who had.questions but we didn't have the answers.at this very moment do me a favor and.put those questions in writing and then.put them on the Oasis mailbox on the web.page and we will be sure to get back to.you and I still have a staff here but.because of time we won't be able to.answer them all but you will get answers.to your questions so again if you called.and asked a question we didn't have the.answer put it in writing and send it to.the Oasis mailbox and you will get an.answer everybody okay all right well.this concludes our broadcast I hope that.it was helpful and informative and it.will help you in getting started with.Oasis I'd like to thank all of our panel.members and you our viewing audience for.participating in this important and.informative broadcast I'm Doris McMillon.good day.you.you.

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When you need to sign a Outcome And Assessment Information Set , and you're not in the office, the CocoSign web application is the answer. Signing and sending a legally binding document will take seconds. Here is what you need to do to sign a document on your phone online:

  1. Use your browser to go to CocoSign and log in. If you don't already have an account, you need to register.
  2. Discover the document that needs to be signed on the device and open it.
  3. Open the document and go to the page to insert your esignature.
  4. Select on 'My Signature'.
  5. Create your designed signature, then download it on the page.
  6. Once you have done, go over it again, select 'Done'.

All these tips won't take long, and once the document is signed, you decide the next step. You can either download it to the device or share it in an email or using a link.

A significant benefit of CocoSign is that you can use it with with any mobile device, regardless of the operating system. It's the ideal method, and it saves cost, it's safe.

How to create an e-signature for the Outcome And Assessment Information Set on iOS?

Creating an electronic signature on a iPhone is not at all hard. You can sign the Outcome And Assessment Information Set on your iPhone or iPad, using a PDF file. You will find the application CocoSign has created especially for iOS users. Just go to search CocoSign.

These are the tips you need to sign the form right from your iPhone or iPad:

  1. Download the CocoSign app on your iOS device.
  2. With your email to generate an account, or sign in with Google or Facebook.
  3. Discover the PDF that needs to be signed on the iPhone or pull it from the cloud.
  4. Discover the place where you want to add the signature; select 'Insert initials' and 'Insert signature'.
  5. Put down your initials or signature, place them correctly, and save changes to the document.

Once finished, the document is ready for the next step. You can download it to your iPhone and send it by email. As long as you have a efficient internet connection, you can sign and send documents instantly.

How to create an electronic signature for the Outcome And Assessment Information Set on Android?

iOS has lots of of users, there's no doubt of that, but most phone users have an Android operating system. To fulfill their needs, CocoSign has developed the software, especially for Android users.

You can get the app on Play Market, install it, and you can start signing documents. These are the tips to sign a form on your Android device:

  1. If you already have a CocoSign account, sign in. If you don't have one yet, you can sign in using Google or Facebook.
  2. Select on '+' to open the document you want to sign, from cloud storage or using your camera.
  3. Discover the place where the signature must be placed and then use the popup window to write your signature.
  4. Insert it on the page, confirm, and save the changes.
  5. The final step is to save the signed document.

To send the signed form, just attach it to an email, and it will reach your clients instantly. CocoSign is the best way to sign many forms every day, all at a low price. It's time to forget all about physical signatures and keep it all electronic.

Outcome And Assessment Information Set FAQs

Check the below common queries about Outcome And Assessment Information Set . Communicate with directly if you still have other queries.

Need help? Contact support

How much do nursing home administrators make?

I actually don’t know the answer to this. Glassdoor gives ranges from $80,000–$125,000 per year with most being somewhere in the middle. In the USA, my experience has been that most nursing home administrators are not nurses. They mostly hold a business degree, although I think the admin. where I currently worked in PT. Administrators train for a year becoming administrators for their own facility.

How do I get my nursing home administrator license?

When I married my first husband, we planned to have children. It wasn’t happening, and our doctor suggested my husband and I get tested, to see if there was a medical reason. He said they started with the man, as the test was easier to conduct. My husband’s test was scheduled, and it found that he had no issues. When we got that news, he said to me “I knew it couldn’t be me. I got a girl pregnant in high school.” I was shocked. First off, we were having difficulties in our marriage, and my husband kept saying “it can’t be me, I’m French”. I actually prayed that there would be a problem with him, Continue Reading

What degree do you need to be a nursing home administrator?

The worst things I saw were what I considered to be abuse/neglect. An example: my first day as a CNA, I was trying very gently to get a lady with dementia up for breakfast. The woman who was “training” me came in angry because I was taking too long. She and another CNA quickly dressed my resident, plopped her in the wheelchair and then pulled a perfume off her dresser. “She likes to wear this disgusting smelling sh!t" Then they sprayed her shirt with the perfume and made a big deal about the perfume “stinking”. This dear lady had tears in her eyes. I didn't know what to do, I was new to this t Continue Reading

How long does an Asperger's assessment outcome take to arrive, and in what method are you told?

I was diagnosed about 6 months ago aged 42. At the time I was assessed I lived on a remote island. I was assessed by a psychiatrist that specialises in Autism via online video conference. I believe the assessment took approximatley 1hr. A short time later I relocated off the island, so needed to find a new GP and get my results transferred. I visited my new GP and went through the results. The results covered how, why, when I was assessed and by who. It documented much of the discussion and diagnosis points. I was also diagnosed for transition disorder and moderate depression. The results also went in to recommendation for short/medium term treatment. I was not impressed with the treatments offered. They did not reflect my past life, or my life circumstances in any way. Indeed the ability of anyone to assess me with 3 significant mental conditions and propose treatments within 1hr discussion is somewhat of a joke, and increased my anxiety and depression in relation to the occupational trauma underlying my transition disorder and moderate depression. Indeed the psychiatrist (let me expand that to all of them), don’t care to know about underlying causes, and believe there silver spoon experiences in the workplace, with little or no understanding of autism in the workplace are doing more harm than good.

How can I add my business location on instagram"s suggested locations?

You can only create a location for Instagram on Facebook. If a location is on Facebook, it automatically appears on Instagram. Facebook owns Instagram. Facebook wants to use Instagram to draw users back to Facebook and use Facebook to draw users to Instagram. Every minute there are eyeballs looking the money is coming in.

How do you set a goal and not let yourself be attached to an outcome? We are told to set goals, yet also get told not to be attached to what the outcome may be. How can I focus on achieving if I’m not focused on a specific outcome?

For me, I always have to have that goal in mind, but I try to make it open ended in nature. So… I'll learn this skill and be successful. Vs I'll learn this skill and become a successful Dr. Because what if the universe has a different result in mind, like you becoming a successful talk show host. I focus on how I want to feel at the end, successful.

If you are filling out job applications, should you set a limit to how many you fill out daily-weekly? Why/why not?

It's often said that searching for a full-time job IS a full-time job. There's no reason from a recruiting standpoint that I would recommend you limit the number of job applications you fill out. In fact, finding a new job is somewhat a numbers game. The more you put yourself out into the market, the more likely it is that a new employer will think you could be a good match for their open role. Depending on what other activities you need to account for, I'd recommend setting a target for how many applications you complete on a daily or weekly basis.If you are already working full-time, consid Continue Reading

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