Surface
Closur reads the clinical documentation your building already produces each day and picks out changes that tend to come before a decline.
An alert nobody closes is a miss.
Every signal gets a name, a time, and a destination.
Closur is nurse-reviewed surveillance for skilled nursing facilities. A registered nurse validates every signal against the record before it reaches anyone, and every finding stays open until it reaches a documented outcome. Closur Clinical catches deterioration before the event. Closur Capture applies the same review to the assessments your reimbursement depends on.
The early signs are already in the chart.
- Nursing note02:14A temperature the night after a hospital return.
Alert fired. No owner. - Meal intake recordDay 2Intake that has slipped two days in a row.
Alert fired. No owner. - Lab order36 hours oldA lab that was ordered and never drawn.
No alert at all. - Night shift note04:50New confusion, charted once and not mentioned at report.
Charted. Not handed off.
What goes missing is ownership. Closur puts it back in three moves.
- Surface
- Validate
- Close
How a signal becomes a closed finding.
Software finds the signals. A nurse decides which ones deserve a clinician's time. The clinician decides the care. Closur keeps the record of all three.
One finding, start to finishLong-stay resident, east hall
- Tue 06:10
Surfaced. Intake down two days running. New confusion charted on nights.
- Tue 08:40
Validated. RN reviewer confirms it in the record: meals at 25 percent, no new orders.
- Tue 08:55
Routed. Sent to the Director of Nursing and the attending NP, evidence attached.
- Tue 11:20
Disposition. NP orders labs and fluids, chooses to monitor. An observation period opens.
- Wed 08:30
Still open. Labs are back and abnormal. Returned to the NP in the morning review.
- Fri 08:35
Closed. Intake recovered, confusion resolved. Outcome recorded: stabilized in place.
Illustrative example, not resident data. External records show roles, never names.
Validate
A registered nurse reviewer checks each signal against the resident's record. Signals that don't hold up stop here, so they never cost your staff a minute.
Route
A validated finding goes to the person who can act on it, the facility's nurse leader or the provider, with the supporting evidence attached.
Record the disposition
The clinician decides what happens next. Closur records who decided, when, and what. Choosing to monitor opens an observation period. It does not close the finding.
Follow it to an outcome
The finding stays active under daily review until the episode is resolved, stabilized, or transferred, and that outcome is documented.
Closur Capture
The same review, applied to the assessment.
Under PDPM and case-mix Medicaid, the assessment is where the care your staff already documented turns into the rate your building is paid. Closur Capture reads the record and the assessment side by side, and a nurse verifies every gap before it reaches your MDS coordinator.
The review runs in both directions. What the record supports but the assessment missed, and what the assessment claims but the record doesn't hold up.
The care is in the chart. The assessment never picked it up.
Nursing notes, therapy notes, and the medication record already describe the resident's real acuity. When the assessment codes something lighter than that, the building is paid for less care than it gave.
Illustrative findingTwo-person assist for transfers and bed mobility documented on every shift for nine days. The current assessment codes one-person assist. On public CMS rate tables, one nursing-tier move is worth roughly $25 to $70 per resident day, depending on the state.
The assessment claims it. The record can't back it up.
Coding that the documentation doesn't support is a survey and audit exposure, not revenue. Capture flags it the same day, while it can still be corrected, and records who corrected it and when.
Illustrative findingIsolation for an active infection coded on the assessment. No active infection, no single-room order, and no isolation precautions in the record for the look-back period. Routed to the MDS coordinator and the infection preventionist before the assessment locks.
One record. Three consequences. One review.
A change in a resident rarely touches only one thing. The same verified finding can have a capture consequence, a clinical consequence, and a quality consequence, each with its own owner, its own deadline, and its own disposition. Closur keeps them under one parent so nothing is worked twice and nothing is dropped.
Verified findingLong-stay resident, north hall
Two-person assist charted every shift for nine days. Assessment codes one-person assist. A fall on day six.
RN reviewer confirmed against the ADL record, the therapy notes, and the incident report. Evidence attached once, shared by every consequence below.
-
CapturePriority 2
Function score doesn't match nine days of documentation.
- Owner
- MDS coordinator
- Due
- Before the assessment locks, Thursday
- Disposition
- Assessment corrected. Case-mix group updated.
-
ClinicalPriority 1
Decline in mobility after a fall, not yet reviewed by a provider.
- Owner
- Attending NP
- Due
- Today
- Disposition
- Provider evaluation and PT screen ordered. Observation open.
-
QualityPriority 2
Fall with a change in function. Care plan not yet updated.
- Owner
- Director of Nursing
- Due
- Within 72 hours
- Disposition
- Care plan revised. Fall review documented.
The priority rule is fixed. Clinical urgency comes first. A finding that touches two consequences outranks one that touches one. A reimbursement consequence never raises a clinical priority.
Illustrative example, not resident data. Roles shown, never names.
Priced per resident day. Never a share of what you recover.
Capture is a compliance function that happens to recover revenue. It is not an upcoding service, and it has no reason to lean on your coding in either direction.
Works inside the look-back window.
The review runs while the assessment is still open, so a gap gets fixed on the assessment that matters. A review after the lock can correct an error. It cannot recover an assessment that was never done.
Doesn't sell you a second detector.
If you already license a case-mix or PDPM tool, Capture works its alerts. The nurse review and the closure record are the product, not another dashboard.
One more thing Capture gives back: the weekly level-of-care meeting. Your interdisciplinary team walks in with findings already verified against the record instead of spending hours hunting for them. Capture is not yet live in a building. A first pilot sets baselines before it starts, including capture rate on locked assessments, mood and function accuracy, and case-mix index, with non-pilot buildings held as a control.
The morning review
Every finding has an owner.Every owner has a time.Nothing closes on its own.
5New since yesterday
8Open loops
12Closed this week
- 117CBC ordered, not drawn at 36 hoursSurfaced 06:10. Waiting on RN review.New
- 112Intake down two days, new confusionValidated 08:40. Routed to DON and attending NP.Open
- 221CaptureTwo-person assist charted nine days, assessment says oneValidated 08:50. Routed to MDS coordinator. Assessment locks Thursday.Open
- 204Temperature the night after hospital returnDisposition: monitor. Observation day 2.Observing
- 309Intake recovered, confusion resolvedOutcome recorded: stabilized in place.Closed
Illustrative example, not resident data.
One list, worked every morning.
Clinical and capture findings sit on the same list, worked by the same reviewer. Open loops come back in the building's next morning review, and the volume is sized to what the building can actually work. Each finding carries its owner and its state across every shift change.
Try it
Same signal. Two endings.
What happens to it
- The alert fires on the night shift.
- The shift changes. The alert is still sitting there.
- Nobody can say who saw it or what was decided.
Fired, and never closed.
Illustrative timelines, not resident data.
What Closur doesn't do.
Buildings don't need more alerts. These are the lines we hold so that Closur takes work off the floor instead of adding to it.
It doesn't send raw alerts.
Nothing reaches a clinician or an MDS coordinator until a nurse has checked it against the record.
It doesn't diagnose or direct care.
Assessment and every care decision stay with the licensed clinicians responsible for the resident. Closur routes, records, and follows up.
It doesn't take a cut of what you recover.
Capture is priced per resident day. A reviewer paid on recovered revenue has a reason to push your coding. Ours doesn't.
It doesn't chase your staff through the shift.
Open loops come back in the building's next morning review, and the volume is sized to what the building can actually work.
It doesn't rotate strangers through your buildings.
Each nurse reviewer keeps the same set of buildings and gets to know the leadership, the charge nurses, and the MDS coordinators in them.
Four groups share one resident. Closur gives them one record.
If you operate buildings
You get a standing record that each signal was seen, reviewed by a nurse, sent to someone, and followed to an outcome. It is there when a family member, a medical director, or a surveyor asks what happened and when. And with Capture, the care your staff documented is the care the assessment reflects, in both directions, before the assessment locks.
If you own the assessment
MDS coordinators and regional reimbursement leads spend the week reconciling the assessment against a record that keeps moving. Capture sends you the gaps a nurse has already verified, with the supporting documentation attached and the lock date on the finding, and records your correction with your role and the time.
If you round in them
Physicians and nurse practitioners covering several buildings can't sort through every alert each one generates. Closur sends you findings a nurse has already validated, with the evidence attached, and records your disposition with your role and the time.
If you carry the risk
Health plans, I-SNPs, and ACOs pay for the transfer that could have been treated in place. Closur gives a risk-bearing partner daily, nurse-reviewed visibility into residents after admission, and a record of what was done about each finding.
We grade ourselves on closure, not on model accuracy.
A model can be right about a resident and still change nothing. These three numbers tell you whether something happened.
- Closure
- Of the findings we route, how many reach a documented outcome. For Capture, that outcome is a corrected assessment before it locks.
- Time to action
- How long it takes to get from a signal surfacing to a clinician's disposition, or to a coordinator's correction.
- Burden per nurse
- How much we ask of the facility's nurses each day. We cap it to what the building can staff.
Fired is not seen. Seen is not closed.
Most alert systems count the first row. Closur is built around the last one.
Alerts fired
Seen by someone
Closed with a documented outcome
Illustration, not measured data. Putting real numbers on these three rows, building by building, is the first job of a Closur pilot.
PLEROS
Closur is built by Pleros Health.
Pleros Health is the company behind the Closur platform. Closur runs three lines on one record, with the same nurse review, the same closure rule, and the same ledger behind each.
- Closur ClinicalDeterioration surveillance. Signals before the event, validated by a nurse, followed to an outcome.
- Closur CaptureAssessment accuracy. The record and the assessment reconciled in both directions, inside the look-back window.Pilot design complete. First buildings being arranged.
- Closur QualityRegulatory and survey readiness, on the same review-and-closure model.In development.
Matt Hearn, RN
Founder
Matt has spent forty years in long-term care nursing. He started as a nursing assistant, became a Director of Nursing, and moved into clinical informatics.
He has worked with facility alert systems firsthand for a decade and watched good alerts go unanswered. Closur is built on what that taught him. Finding the signal was never the hard part. Closing it was.
Let's talk about your buildings.
We are arranging our first pilot buildings now. If you run skilled nursing facilities, own the assessments in them, round in them, or carry risk for the residents in them, we would like to hear how alerts get handled where you are.