02/29/2024

Survey Tip of the Week: Psychosocial Outcome Severity Guide

In Ohio during 2023, the F600 abuse tag ranked as the second most cited immediate jeopardy F-tag. Although psychosocial harm is most frequently referenced in the surveyor guidance for abuse, surveyors are to evaluate the resident for a negative psychosocial outcome across all regulatory tags. CMS instructs surveyors to use the Psychosocial Outcome Severity Guide to determine the severity of a deficiency that resulted in, or may result in, a negative psychosocial outcome. Surveyors are to select the level of severity for the deficiency based on the highest level of physical or psychosocial outcome. Below are CMS examples of a negative psychosocial outcome at different severity levels:

• Fear/anxiety that may be manifested as panic, immobilization, screaming, and/or agitated behavior(s) (e.g., trembling, cowering); avoidance of the situation(s), person(s) or place; preoccupation with fear; resistance to care and/or social interaction; sleeplessness; fear of speaking, and/or verbal expressions of fear.
• Expressions (verbal and/or non-verbal) of moderate pain or physical distress (e.g., itching, thirst) that has compromised the resident’s functioning such as diminished level of participation in social interactions and/or ADLs, intermittent crying and moaning, or loss in interest for eating. Pain or physical distress has become a central focus of the resident’s attention, but it is not severe or overwhelming.
• Complaints of boredom and/or reports that there is nothing to do.

LeadingAge Ohio encourages facilities to use the guide to evaluate a resident’s psychosocial well-being and their response to events. Facilities should evaluate what documentation is lacking in the record. Documentation should clearly reflect if expressions are in alignment with the resident’s baseline or a true change for that resident. CMS notes that the presence of a given affect (i.e., behavioral manifestation of mood) does not necessarily indicate a psychosocial outcome that is the direct result of noncompliance. A resident’s reactions and responses (or lack thereof) also may be affected by his/her pre-existing psychosocial issues, illnesses, medication side effects, and/or other factors. Because many nursing home residents have sadness, anger, loss of self-esteem, etc. in reaction to normal life experiences, the survey team must determine that the negative psychosocial outcome is a result of the noncompliance and not a pre-existing condition for the resident. 

The Psychosocial Outcome Severity Guide can be found in the Survey Resources zip file on the CMS Nursing Home webpage and under the downloads section on this CMS webpage.

The State Operations Manual Appendix PP provides additional guidance on negative psychosocial outcomes. 

LeadingAge has developed webinars and resources on the requirements of participation which are located on the LeadingAge learning hub. LeadingAge continues to add QuickCasts on the regulatory groups.  Updated resources have also been added on the Nursing Home RoP Tools and Resources webpage.  

For more information about the updated requirements of participation and citations occurring in Ohio, please join us on the monthly STAT: Survey Tips and Tactics call. Register now for the March 13 call at 11:00AM. LeadingAge Ohio is sharing tips to assist members during the survey process. Send questions you would like addressed in future Tips of the Week to Stephanie DeWees at sdewees@leadingageohio.org.