A nursing home worker places a doll on a resident's bed.
On Friday, April 10, CMS issued its new interpretive guidelines for state surveyors.
These guidelines provide surveyors with detailed information on how to assess nursing home compliance with OBRA 1987 regulations, which cover issues related to physical environment, resident rights, and resident health and safety.
The changes, which go into effect on June 17, 2009, are intended to support efforts underway to transform nursing homes into “homey” environments through both environmental changes and resident-centered caregiving. Whereas in the past, these changes were sometimes stymied by fear that regulators would cite organizations for deficiencies, CMS is now making it clear that the OBRA regulations should be interpreted to support personal choice in the full range of daily activities, including waking, bathing, dining, and sleeping. The new guidance also calls for visitors to have 24-hour access to residents, regardless of familial relationship.
The new interpretive guidelines call on nursing homes to begin or to continue de-institutionalizing their physical environments. Suggestions include: reducing noise such as overhead paging and alarm bells, eliminating nursing stations, taking down institutional signage, and refraining from serving meals on institutional trays.
According to the CMS memo: “A ‘homelike’ or homey environment is not achieved simply through enhancements to the physical environment. It concerns striving for person-centered care that emphasizes individualization, relationships, and a psychosocial environment that welcomes each resident and makes her/him comfortable.”
The new CMS interpretive guidelines are the outcome of last April’s historic symposium hosted by CMS and Pioneer Network. That conference focused on the impact of innovative environmental design on creating home and community for nursing home residents. Long-term care innovators, regulators, researchers, architects, advocates and public officials came together in an unprecedented dialogue to discuss regulatory challenges and other issues associated with transforming the physical environments of nursing homes into comfortable, pleasurable places for elders to call home.
“These new interpretive guidelines are an incredible opportunity and a real challenge,” says Susan Misiorski, PHI’s Director of Organizational Culture Change. “PHI partners with nursing homes throughout the country to make these very changes. We help organizations assess their current practices and determine how to move toward a more “relationship-centered” culture that first and foremost supports resident choices. To get there, we have found that staff need to strengthen core skills, particularly those related to communication, problem-solving and relationship building. It takes time, but the results are a far more empowering and satisfying environment for both staff and residents.”
PHI will be participating in a June national webinar series designed to help providers understand what the new interpretive guidelines mean for them.
I don’t want to be a “doubting Thomas”; however, I attended our state conference, LSN, and listened to a presentation from members of CMS. They clearly stated, even with good documentation supporting the care plan of person-directed care, the regulations will always win. One man stated, “It sounds like CMS is talking out of both sides of their mouths” and I have to agree. I pray I’m proved wrong.
The regulations are coming into direct conflict with person centered care more and more. It’s like CMS doesn’t communicate amoung themselves. While I can see the safety reason behind the updated Infection Control, Kitchen Sanitation as well as this update: It places resident centered care, with personal choices in direct conflict with safety regulations. So what it is, Resident Rights or Safety?
Personally, I eat raw cookie dough and love sunny side eggs…I willingly place myself in “Immediate Jeopardy”
I believe this a step in the right direction but it remains to be seen who wins- State Surveyors or Residents. At my facility the Life Safety people have made it so most vof our residents have to spend most of their time in their rooms unless the ambulate or move their wheelchairs independently. This is so unfair as many of our people like to sit in the halls or at the nurses station where all the action is. Our state surveyors definitely need 101 Culture Change. I for one want to be able to make my own choices and be able to sit where I want when I become a resident. Do the state surveyors not sit at home where they chose? Why not our residents?
I hope that these new changes will include a better staff to resident ratio. I am a frustrated nursing assistant who is tired of being given 14-18 total care residents to care for by myself.
Home like environments will do much to secure a better lifestyle for the elderly customer. The nursing staff, however, will fight this. Initially at least.
Nurses and aides like to use “Safety” as an excuse for the institutional setting we’re so used to. In reality it is staff convenience that drives that setting. Until nursing staff can be educated on the benefits of homelike living, culture change won’t happen.
CMS should start thinking “culture change” instead of “homey environments.” The terms may sound the same but they have a differnt meaning in the nursing home environment. We need to realize that people are moving into a new home to live not die. The environment should be no different than living at home except that you require more help with the daily living process. You do not lose the right to be the person that you were before you changed homes. You should have privacy for yourself and visitors, dignity and respect for you as a person. You shoule have a relationship with the community – attending church activities, shopping, exercise programs, museum visits if you desire. I know some or all of these activities are offered but many people get left out for various reason – lack of transportation for instance – assistance is required.
I am speaking from the standpoint of homes where people are not self pay.
These new rulings are great, the building I teach in currently is trying to produce the “homey” enviornment. I think it’s great. My folks are in their 80’s and live in their home, and it’s homey. If they had to move in a facility I know they would want that “homey ” environment. The staff is working hard to provide a safe and healthy enviornment for the residents. It’s taking time but this facility working towards a homey sitting.
I think a home-like setting is a fantastic requirement for nursing homes. Nothing is more disheartening than to see elders who have lived tremendous, long lives being placed in a stale, tacky, unwelcoming nursing home. Kudos to these guidelines.
This is their home,but they are sometimes not treated as such.Because people who set the guildlines forget this. Without these Grandma,Gramppa,Mothers,Fathers,ect.we would not have the jobs that we all LOVE and CARE about.
to beacome homme based care worker what you must heve so that you can work
The facilities fall short of the goals of a home-like environment for the residents. I think some feel because they place furniture in the facilities that represent a home environment that this is enough. Not until the staff realize that their application of skills and integration of knowledge combined with respecting the residents’right of choice will we have a true home-like environment.Implementing effective channels of communication and acting on the resident’s and their family requests will there be a true home-like environment.