In response to concerns about sub-optimal nursing home care, the Centers for Medicare & Medicaid Services recently released new nursing home regulations. These regulations have become part of the Code of Federal Regulations (CFR), and they apply to any nursing home that accepts Medicaid or Medicare reimbursement (in other words, almost all of them). Unless otherwise noted, the new regulations became effective on November 28, 2016, except for the new baseline care plan requirements, which go into effect a year later. Following are some highlights of the regulations:
- The nursing home must develop a baseline care plan for the resident within 48 hours of admission.
- An assessment that includes the resident’s “needs, strengths, goals, life history and preferences” must be completed within two weeks of the resident’s admission. Further assessments must take place at least annually and whenever there is a significant change in the resident’s condition. The assessment must be based on communication with and observation of the resident and communication with all direct care staff that interact with the resident.
- A comprehensive care plan must be developed within seven days of the completion of the baseline care plan.
- The care planning team must include the resident’s nurse aid, the resident’s representative (a relative, attorney, etc.) and, if possible, the resident.
- Discharge planning is required.
The Baseline Care Plan
The baseline care plan must include physician’s orders, dietary orders, therapy services and social services, along with a list of goals for the resident. It must be presented in summary form to the resident as well as the resident’s representative.
The Comprehensive Care Plan
A comprehensive care plan is a more detailed version of a baseline care plan. The regulations require that it be “person-centered”, which means that the resident must be given the maximum control over his/her own care to the extent possible. The plan must be prepared by a physician, a registered nurse, a nurse aid and a member of the dietary staff, the first three of which must bear responsibility for that particular resident. The resident or the resident’s representative can request that an additional staff member participate, and the nursing home may add staff to the team if it is considered appropriate in light of the resident’s needs.
The goal of the plan must be to maximize the resident’s physical, mental, psychological and social well-being. It must include:
- Goals and deadlines for meeting the resident’s needs;
- A list of the services that will be provided (and if the resident has refused certain services, this must be noted);
- The resident’s goals, which must be worked out with the resident and his/her representative; and
- An assessment of the resident’s potential for discharge from the nursing home, along with the resident’s personal preference with respect to discharge.
The Discharge Plan
The new regulations encourage residents to integrate back into the community as soon as feasible. The care team, the resident and his/her representative must all be involved in creating the discharge plan, which is to be incorporated within the comprehensive care plan.
The discharge plan must include the resident’s goals and care preferences; information from agencies that can help the resident re-integrate into the community (if the resident expresses an interest and if discharge is feasible); and documentary evidence in support of any conclusion that discharge is not advisable, along with the same of the person who made this determination. The feasibility of discharge should be re-evaluated at regular intervals and should be modified if necessary.
Hopefully, these new regulations will substantially improve the quality of life of nursing home residents nationwide.