Keystone Insights
Practical Insights for Skilled Nursing Leaders
CMS updates, readmission news and everyday geriatric care tips, written for administrators, DONs and the teams on the floor.
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CMS Updates
FY 2027 SNF Final Rule: What Changes for Your Facility
CMS finalized a 2.4% Medicare Part A update for FY 2027, plus VBP, quality reporting and MDS changes. Here is what each one means for your building.
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Readmissions
The New SNF VBP Readmission Measure: What Counts Starting FY 2028
In FY 2028, SNF VBP swaps its 30-day all-cause readmission measure for one that counts only preventable readmissions during the stay.
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Geriatric Care
The Changes CNAs See First and How to Pass Them On
CNAs often spot the first signs a resident is getting sick. Here is how Stop and Watch and SBAR help move those observations to the nurse, and what the research shows.
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Geriatric Care
Heart Failure Residents: The First Two Weeks After a Hospital Stay
Heart failure residents are at high risk soon after a hospital stay. Daily weights, clear reporting, diet orders and follow-up visits help teams spot trouble early.
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Geriatric Care
Medication Reconciliation at SNF Admission: Where Mismatches Hide
Medication mismatches are common when residents arrive from the hospital. Learn where they hide, who checks what and a simple admission checklist.
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Geriatric Care
Quiet Delirium: When a Sleepy Resident Is Actually Sick
Hypoactive delirium can look like tiredness or withdrawal. How common it is at SNF admission, how it is screened and what staff should watch for and report.
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Geriatric Care
Missed Sepsis or Over-Treated Urine? Getting Infection Calls Right
Nursing home teams must catch early sepsis without treating every positive urine culture. Here is what to observe, report and document.
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Geriatric Care
Goals-of-Care Conversations in the First 72 Hours After Admission
Early goals-of-care and code status conversations help SNF teams honor resident wishes and avoid unwanted hospital transfers.
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Geriatric Care
Falls in the First Weeks After SNF Admission: Why Risk Peaks Early
Fall and fracture risk is highest soon after admission. Here is what drives early falls and how SNF teams can respond.
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Geriatric Care
Weekend and After-Hours SNF Admissions: Closing the Coverage Gap
Evidence on weekend SNF admissions is limited, but the coverage gaps are real. Practical system steps to make off-hours admissions safer.
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Geriatric Care
Preventing Pressure Injuries in New SNF Admissions: The First Days
Why the first days after admission matter for skin, and how a thorough skin check, Braden scoring and clear reporting help prevent pressure injuries.
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Geriatric Care
Appetite Loss, Dehydration and Weight Loss: Early Warning Signs in SNFs
Why a drop in eating, drinking or weight is often the first sign of trouble in older residents, and how SNF teams can monitor, report and respond.
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Geriatric Care
Breathing Changes in Residents With COPD or After Pneumonia
Early breathing changes to notice and report in residents with COPD or recent pneumonia, plus oxygen safety, aspiration risk and vaccination basics.
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Geriatric Care
Planning a Safe Discharge Home From a SNF So Residents Don't Bounce Back
How SNF teams can plan discharges that hold: start early, teach with teach-back, hand off medications clearly, line up follow-up and call after discharge.
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