CMS Finalizes Commitment to Person-Centered Care for Nursing Home Residents

Q. My father has Alzheimer’s, and he is no longer able to live safely on his own. Since my mother died, I have been his caregiver, and although trusting his care to strangers isn’t going to be easy, I know a nursing home is the right place for him at this time. My husband and I have been visiting and touring skilled care facilities in the area to try to find a good fit. How do I know if a place is the right one? When talking to the admission staff, I heard the term “person-centered” care being mentioned a lot. What does that refer to and does our government do anything to ensure quality care for nursing home residents? Also, how do I pay for long-term care when the cost for five months is more than what I make in a year (and dad doesn’t have that kind of money either)? Thanks for your help!

A. More than 15 million Americans devote time and energy to caring for a loved one with Alzheimer’s disease or other dementia, according to the Alzheimer’s Association, but sometimes a loved one’s health needs become too much to handle at home. At that point, as you are aware, you begin to look at other options, such as nursing home care.

When searching for the right nursing home, many people rely on online rating sites alone. When it comes to quality of care, in my experience with clients and in writing the Nursing Home Survival Guide, I have found that while online rating sites are worthwhile, they do not tell the whole story. There are also some important things you should do (and look out for) before selecting a nursing home for a loved one:

• Consider what is important to you—nursing care, meals, physical therapy, a religious connection, hospice care, or Special Care Units for dementia patients? Do you want a place close to family and friends so they can easily visit?
• Take a tour during regular business hours.
• Have a meal.
• Schedule another visit late in the evening or on a Sunday afternoon, to get a sense of round-the-clock life in the facility.
• Pay attention to smells, sounds, and temperature.
• Talk with friends, relatives, social workers, and religious groups to find out what places they suggest. Check with healthcare providers about which nursing homes they feel provide good care. Use their suggestions to make a list of homes that offer the types of services you want.
• Observe whether residents are engaging in activities or sitting around listlessly. Also, ask the administrator about activities for residents. There should be calendars of activities posted in elevators and around the facility on bulletin boards.
• Check the bulletin boards for information on resident and family council meetings. Leaders of these groups, which advocate for residents in the home, can provide insight on any concerns about the facility.
• Observe whether residents are sitting around waiting to be fed at mealtimes or waiting to go to bed after dinner. If so, the facility probably doesn’t have enough staff.
• Ask about the level of staff turnover, which tends to be fairly high in nursing homes. If they’ve had four administrators in one year, it may be a red flag.
• Ask the facility if it practices “consistent assignment,” meaning that the same aide is assigned to care for the resident each day. In facilities that don’t use consistent assignment, residents can have as many as 20 or 25 different people caring for them in a month.
• Ask about the ratio of staff to residents. A good minimum ratio would be about one to five during the day, one to ten in the evening, and one to fifteen at night.Please keep in mind that nursing homes have to meet certain standards. The Centers for Medicare and Medicaid Services (CMS) requires each State to inspect any nursing home that gets money from the government, which is almost all of nursing homes. Homes that don’t pass inspection are not certified. Ask to see the current inspection report and certification of any nursing home you are considering. Visit www.medicare.gov for more information.

In conjunction with the things described above or if you need to make a decision about a facility quickly, Medicare.gov’s Nursing Home Compare is a very helpful resource for consumers, as it offers 1 to 5 star ratings for all nursing homes that participate in Medicare (for short-term rehabilitation) or Medicaid (for long-term care). The ratings are based on the facility’s performance on health inspections, staffing hours for nurses and nursing assistants, and quality measures, such as the prevalence of pressure ulcers and falls among residents.

What is Person-Centered Care and What is the Federal Government Doing to Ensure it?

Person-centered care promotes the importance of keeping the person at the center of the care planning and decision-making process. It promotes choice, purpose, and meaning in daily life. With person-centered care, nursing home residents are supported in achieving the highest level of physical, mental, and psychosocial well-being that is individually practical. In addition, the staff places a premium on active listening and observing, so staff can adapt to each resident’s changing needs regardless of cognitive abilities.

This week, the Centers for Medicare Medicaid Services (CMS) issued a final rule to make major changes to improve the care and safety of the nearly 1.5 million residents in the more than 15,000 long-term care facilities that participate in the Medicare and Medicaid programs. The policies in this final rule are targeted at reducing unnecessary hospital readmissions and infections, improving the quality of care, and strengthening safety measures for residents in these facilities. According to CMS,”(t)hese changes are an integral part of its commitment to transform our health system to deliver better quality care and spend our health care dollars in a smarter way, setting high standards for quality and safety in long-term care facilities.”

The changes announced are part of the first comprehensive update since 1991. This rule will bring best practices for resident care to all facilities that participate in Medicare or Medicaid, implement a number of important safeguards that have been identified by resident advocates and other stakeholders, and include additional protections required by the Affordable Care Act. CMS received nearly 10,000 public comments, which were considered before finalizing this rule.

The health and safety of residents of long-term care facilities are our top priorities,” said CMS Acting Administrator Slavitt. “The advances will give residents and families greater assurances of the care they receive.”

Changes finalized in this rule include:

• Strengthening the rights of nursing home residents, including prohibiting the use of pre-dispute binding arbitration agreements.
• Ensuring that nursing home staff members are properly trained on caring for residents with dementia and in preventing elder abuse.
• Ensuring that nursing homes take into consideration the health of residents when making decisions on the kinds and levels of staffing a facility needs to properly take care of its residents.
• Ensuring that staff members of nursing homes have the right skill sets and competencies to provide person-centered care to residents. The care plans developed for residents will take into consideration their goals of care and preferences.
• Improving care planning, including discharge planning for all residents with involvement of the facility’s interdisciplinary team and consideration of the caregiver’s capacity, giving residents information they need for follow-up after discharge, and ensuring that instructions are transmitted to any receiving facilities or services.
• Allowing dietitians and therapy providers the authority to write orders in their areas of expertise when a physician delegates the responsibility and state licensing laws allow.
• Updating the nursing home’s infection prevention and control program, including requiring an infection prevention and control officer and an antibiotic stewardship program that includes antibiotic use protocols and a system to monitor antibiotic use.

The final rule is available on the Federal Register at https://www.federalregister.gov/public-inspection.

Affording Nursing Home Care

Similar to your situation, most of us are concerned about the affordability of nursing home care. This is a legitimate concern, as nursing homes in Northern Virginia cost $10,000-14,000 a month. To protect your family’s hard earned money and assets from these catastrophic costs, there is no time like the present for your father to begin Medicaid Asset Protection Planning. Please call us to make an appointment for a no-cost initial consultation:

Fairfax Elder Law Attorney: 703-691-1888
Fredericksburg Elder Law Attorney: 540-479-1435
Rockville Elder Law Attorney: 301-519-8041
DC Elder Law Attorney: 202-587-2797