You Asked... We Answered

You Asked: How often must a Braden Scale form be completed?

We Answered: Federal regulations do not require use of a specific pressure injury risk assessment tool like the Braden Scale. However, facilities must assess each resident’s risk for developing pressure ulcers/injuries (PU/PIs) and reassess risk whenever clinically indicated. Facilities identify how they plan to do that through their policy.

Many clinicians use a standardized tool, such as the Braden Scale, as part of this process. Common best practice includes completing a Braden assessment:

• Upon admission
• Weekly for the first four weeks
• Quarterly
• With any significant change in condition 

This frequency aligns with evidence showing that 80% of pressure injuries in skilled nursing facilities develop within the first two weeks of admission, and 96% develop within three weeks, underscoring the importance of close early monitoring.

Risk assessment is not score-driven alone. Surveyors expect clinicians to evaluate all risk factors, even those not fully captured by a standardized tool. These risk factors may include:

• Impaired mobility or functional decline
• Co-morbidities (e.g., diabetes, ESRD, thyroid disease)
• Medications affecting healing (e.g., steroids)
• Impaired blood flow or vascular disease
• Cognitive impairment or refusal of care
• Urinary or fecal incontinence
• Malnutrition, undernutrition, or dehydration
• History of a previously healed pressure injury (especially prior Stage 3 or 4)

Some risk factors are not fully modifiable (such as permanent loss of sensation), while others, like pressure or positioning, can often be addressed immediately. Additional reassessment is expected when a resident experiences an acute illness or condition change (e.g., infection, pneumonia, CHF exacerbation).

Finance Strategy Workshop - March 12

Senior living organizations are operating amid changing insurance and financing models, with growing pressure to adjust long-term financial assumptions. This one-day program convenes finance leaders from Ohio, Indiana, and Kentucky for focused discussion of national senior living trends and their implications for nonprofit providers.

Designed for finance professionals, the session centers on concrete approaches to long-range planning in an increasingly complex operating environment, including new cybersecurity threats, strategies for containing construction costs, and case studies in mergers/acquisitions. 

For complete details, including the agenda for the day, click here.

Presentation Proposals Due Monday for 2026 Annual Conference

LeadingAge Ohio welcomes members and partners to submit proposals for the 2026 Annual Conference and Trade Show, August 25–27, at the Hilton Columbus at Easton. This year’s conference celebrates Changemakers—leaders and teams advancing aging services through new ideas, tested approaches, and collaborative practice.

Proposals across all topic areas are welcome, with particular interest in home health and hospice, clinical practice and quality, reimbursement, marketing and communications, philanthropy, leadership development, technology, artificial intelligence, and workforce issues. Sessions should offer clear applicability for provider settings and avoid promotion of proprietary products. 

The submission deadline is Monday, January 26, 2026. Full details and the application portal are available on the Call for Presentations page.

Questions may be directed to Corey Markham, Director of Education and Business Development, at CMarkham@leadingageohio.org.

Navigating the 2025 Tax Law: What Nonprofits and Donors Need to Know

The Philanthropy Network invites organization leadership and development and finance professionals to join Paul Yeghiayan, CFRE, for a virtual presentation on how the new tax law will reshape the philanthropic landscape. With most provisions taking effect January 1, 2026, this session will help nonprofit leaders understand what’s changing, how it may influence donor behavior, and why it’s critical to engage donors now. Paul will unpack key impacts for high-net-worth and everyday donors and offer strategic guidance you can use today to support your fundraising success in the year ahead.

This presentation will take place January 29 at 10 a.m.  Members may join here.

Take Action: Make Medicare Telehealth Waivers Permanent

Since March 2020, Medicare telehealth waivers have expanded access to care by allowing services to be delivered across settings, geographies, and technologies, including audio-only options. These flexibilities are critical for home health and hospice providers, particularly for conducting face-to-face certifications and recertifications. Temporary extensions have created repeated disruption, underscored most recently during the federal shutdown, when lapses caused confusion and threatened access to care.

There is broad, bipartisan agreement that Medicare telehealth flexibilities should be made permanent. Without congressional action, providers and older adults will continue to face uncertainty tied to short-term extensions.

What to Do

Urge your House and Senate members to support the CONNECT for Health Act of 2025 (S. 1261 / H.R. 4206) to permanently authorize Medicare telehealth flexibilities and prevent another telehealth cliff.

Proposal to Extend Esther’s Law to Assisted Living Continues to Evolve

Ohio policymakers and stakeholders, including LeadingAge Ohio, are continuing discussions on yet-to-be-introduced legislation that would extend Esther’s Law — which allows residents to authorize electronic monitoring in long-term care settings — to assisted living communities.

During a January 21 stakeholder call hosted by the Office of the State Long-Term Care Ombudsman, providers, advocates, the bill sponsors and their legislative staff reviewed recent language revisions and raised additional implementation questions.

The bill would add residential care facilities (RCFs) to Ohio’s electronic monitoring statute, giving assisted living residents the same rights currently available in nursing facilities.

In response to stakeholder feedback, the latest draft removes a previously proposed $50 cap on installation costs. Instead, it allows facilities to charge residents only the actual cost of time and materials for installation, while clarifying that residents may not be charged for facility-wide internet or infrastructure upgrades.

The proposal also affirms that residents may select their own monitoring devices, so long as they are compatible with the facility’s internet infrastructure.

For Medicaid beneficiaries, the bill would cap monitoring-related charges — including installation and internet access — at 10% of the resident’s monthly personal needs allowance (PNA).

Providers raised questions about how the law would function in assisted living settings with high resident turnover. Some noted that a resident-by-resident installation model could require frequent device changes, creating staffing and IT challenges.

To address this, stakeholders discussed whether the bill should explicitly allow facilities to offer a standardized, facility-wide camera option as one way — but not the only way — to comply. Under this concept, residents could choose a facility-provided system or bring their own device under existing Esther’s Law protections.

Participants also flagged concerns related to cybersecurity and privacy. Providers expressed unease about connecting a wide range of third-party devices to facility Wi-Fi networks and the potential exposure to hacking or data breaches.

Related questions were raised about HIPAA and liability, particularly if facilities are required to provide internet connectivity for devices that transmit highly sensitive video footage. Stakeholders suggested additional legal review to clarify responsibilities and risk exposure.

While the bill includes cost protections for Medicaid residents, providers noted that connectivity and IT support costs would still be absorbed by facilities. Stakeholders suggested exploring whether CMP funds or other technology-related funding sources could help offset those expenses.

No final decisions were made during the January 21 call. Legislators and stakeholders agreed that the proposal reflects meaningful progress but may require further refinement. Additional legal review and continued stakeholder engagement are expected as the legislation moves forward.

Federal Bill Would Expand Clinical Authority in Skilled Nursing Facilities

New federal legislation would allow nurse practitioners, physician assistants, and clinical nurse specialists to perform required clinical assessments and oversee resident care in skilled nursing facilities without duplicative physician involvement. The Enhancing Skilled Nursing Facilities Act would remove federal rules that currently require a physician to repeat assessments already completed by advanced practice clinicians in order for Medicare or Medicaid payment, despite many states permitting these providers to work independently within their scope of practice.

LeadingAge has endorsed the bill, citing persistent workforce shortages across skilled nursing facilities, particularly among physicians and geriatricians. Supporters argue the change would reduce administrative burden, improve access to timely care, especially in rural and underserved areas, and help prevent avoidable hospitalizations by allowing qualified non-physician clinicians to serve as treating providers when physicians are not readily available.

Read more in McKnight’s Long-Term Care News.

MedPAC Recommends 4% Medicare Pay Cut for Nursing Homes Amid MA Pressure

The Medicare Payment Advisory Committee voted January 15 to recommend a 4 percent reduction in Medicare payments to skilled nursing facilities for fiscal year 2027, citing projected Medicare margins of 25 percent despite declining facility supply and utilization through 2024. MedPAC’s analysis focuses on fee-for-service Medicare, which represents a median 8 percent of nursing home stays nationally.

Several commissioners acknowledged that the recommendation does not fully account for mounting pressure from Medicare Advantage, Medicaid underfunding, and workforce instability, noting the need for broader, cross-payer analysis to assess overall financial viability. MedPAC also voted to recommend a 7 percent payment reduction for home health agencies, with all recommendations set to be included in the commission’s March report to Congress. For more details, read the full article at McKnight’s Long-Term Care News.

Survey Tip of the Week: Dining Dignity

Residents have the right to a dignified existence, and surveyors closely observe how dignity, independence, and comfort are promoted during meals. Under F550, dining practices and environments must support both quality of life and nutritional intake. Surveyors commonly cite concerns when they observe the following: 

• Daily use of disposable cutlery and dishware 

• Bibs or clothing protectors instead of napkins (except by resident choice) 

• Staff standing over residents while assisting them to eat 

• Staff interacting/conversing only with each other rather than with residents while assisting with meals 

Appetite is influenced by more than the food itself. The aroma, flavor, appearance, temperature, and overall dining experience all impact intake. Uncomfortable, noisy, or disruptive dining environments can directly contribute to poor nutritional outcomes. 

The Long-Term Care Survey Process (LTCSP) instructs surveyors to observe for: 

• Flexible dining schedules and dining styles that support resident choice 

• Meals that are palatable, visually appealing, and served at proper temperatures 

• Dining spaces that are calm, welcoming, and conducive to eating—whether in the dining room or resident rooms 

Dining, activity, and common areas must be large enough to comfortably accommodate residents, including those using wheelchairs, walkers, or other mobility devices. “Sufficient space” means: 

• Residents can access the area without restriction 

• The space is not functionally off-limits 

• Residents can move and function freely once inside 

Dining areas should also be adequately furnished to meet varying physical and social needs. Surveyors are instructed to observe whether furnishings are: 

• Structurally sound and functional 

• Appropriately sized (e.g., chairs of varying heights, tables that accommodate wheelchairs) 

The Long-Term Care Survey Process directs surveyors to assess whether dining areas are structurally sound and functional, including whether furnishings accommodate varying resident needs (e.g., chairs of different sizes and tables that allow wheelchair access). Surveyors will also verify air temperatures above floor level in resident rooms, dining areas, and common spaces, noting concerns if temperatures fall outside the 71–81°F range.

Check out the LeadingAge Ohio Education Calendar!

LeadingAge Ohio holds valuable education webinars and in-person events throughout the year. Opportunities are added weekly. See the complete Schedule of Events.