The Centers for Medicare & Medicaid Services (CMS) released new and revised rules last year governing nursing homes. These rules are the first significant changes to the rules governing nursing homes since 1991, and also enacted rules created under the Affordable Care Act in 2011. These rules are being implemented in three phases: the first in November of last year, the second on November 28th of this year, and the final phase by November 28th of next year.
The final rules are designed to:
- strengthen the rights of long-term care facility residents, including prohibiting using pre-dispute binding arbitration agreements;
- ensure that long-term care facility staff members are properly trained on caring for residents with dementia and in preventing elder abuse;
- ensure that long-term care facilities consider the residents’ health when making decisions on the kinds and levels of staffing a facility needs to properly take care of its residents;
- ensure that staff members have the right skills and competencies to provide ‘person-centered’ care to residents. The care plans developed for each resident will consider each person’s goals for care and his or her preferences;
- improve care planning, including discharge planning for all residents that involve the facility’s interdisciplinary team and considers the subsequent caregiver’s capacity, give residents information they need for follow-up after discharge, and ensure that instructions are properly provided to any facilities receiving the patient or subsequent services;
- allow dietitians and therapy providers with the authority to write orders in their areas of expertise when a physician delegates the responsibility and state licensing laws allow; and
- update the long-term care facility’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.
What has grabbed most of the public attention is the broad revision of §483.12. Entitled “Freedom from abuse, neglect, and exploitation,” the new regulation proposes to ensure the right of nursing home residents to be free from “abuse, neglect, misappropriation of resident property, and exploitation” by prohibiting “corporal punishment, involuntary seclusion and any physical or chemical restraint not required to treat the resident’s medical symptoms.” It will also ban those who have been dismissed from previous jobs because they were found guilty of neglect from being employed by another nursing home. The regulation also imposes reporting requirements, within two hours of ‘reasonable suspicion’ if there is bodily injury, and within 24 hours if there is no bodily injury, that an abuse crime has been committed. This reporting requirement is effective as of November 28, 2017. The regulation also provides that nursing home residents are to be informed of these requirements on a yearly basis.
The key to guarding against such elder abuse is to know the law and the regulations, to make sure that the facility in which is loved one is staying complies with those rules, and to know the warning signs. If you suspect abuse, contact Adult Protective Services. Telephone numbers for agencies in each state are available here.