Psychosocial decompensation affecting the skilled course: a new, marked drop in mood and engagement with refusal of therapy and ADL over two days and reduced intake — an adjustment/depressive reaction stalling the skilled plan and threatening functional decline. The change assessed, the mood screen updated, non-pharmacologic support and structured engagement intensified, the provider and social services notified, the plan re-evaluated and adjusted to re-engage the resident, and the care plan revised. Will reassess participation and mood; supports Section D/Q. Skilled recognition and management required, as the psychosocial change is undermining the reasonable-and-necessary skilled care.

Caregiver-capacity gap threatening a safe discharge: the identified caregiver unable to demonstrate the required care (medication management and transfers) and expressing that they cannot safely manage at home — a discharge-safety problem. Skilled teaching intensified with a structured plan and return-demonstration, social services and the team engaged, alternative supports explored, and the discharge plan and goals revised with the representative. Will reassess competence; supports Section Q. Skilled teaching and discharge coordination required.