Calling the Shots: Nursing News and Notes

New Federal Rules Ahead for Long-Term Care Facilities

New Federal Rules Ahead for Long-Term Care Facilities

Thursday, August 13, 2015

What will the landscape look like for older Americans in the next decade? The recent White House Conference on Aging (WHCoA) convened to tackle important issues for senior citizens, as well as shape policy for the next 10 years. The once-a-decade conference has been meeting since the 1960s to identify and advance actions to improve the quality of life of older Americans.

This latest WHCoA observed a few significant milestones.  2015 marks the 50-year anniversary of the Older Americans Act, Medicare and Medicaid, and it is also the 80th anniversary of Social Security. These key programs have been integral to the health and welfare of America’s senior citizens, but the Obama administration believes it’s time for some major improvements.  Hoping to modernize the rules that nursing homes must follow to qualify for Medicare and Medicaid payments, the White House unveiled its plans at the latest WHCoA.

The last time these rules were addressed was 30 years ago – and healthcare delivery has greatly advanced in that time. "The existing regulations don't even conceive of electronic communications the way they exist today," said Dr. Shari Ling, Medicare's deputy chief medical officer. "Also there have been significant advances in the science and delivery of healthcare that just weren't imagined at the time the rules were originally written. For example, the risks of antipsychotic medications and overuse of antibiotics are now clearly known, when previously they were thought to be harmless."

Hundreds of pages of proposed changes are designed to address issues for residents in the nation’s more than 15,000 long-term care facilities – covering everything from meals to medications to staffing. Some of the new rules are required by the Affordable Care Act, as well as the president’s executive order directing agencies to simplify regulations and minimize compliance costs.

Some of the specific guidelines include:

  • A section on electronic health records
  • Measures to ensure that patients and/or families are involved in care planning and discharge
  • Specific infection control procedures
  • Directives to minimize the use of antibiotic and antipsychotic drugs
  • Measures to reduce hospital readmissions
  • Requirements to provide nutritious alternative meals and snacks for residents who want to eat at other non-scheduled meal times
  • Provisions for nursing home residents to choose their own roommates
  • Requirements for nurses and staff to have specific dementia training

"Today's measures set high standards for quality and safety in nursing homes and long-term care facilities," said Health and Human Services Secretary Sylvia Burwell. "When a family makes the decision for a loved one to be placed in a nursing home or long-term care facility, they need to know that their loved one's health and safety are priorities."

One thing missing from the proposed nursing home rules is a recommendation for staffing ratios, which may disappoint consumer advocates who had hoped for such a rule. "We believe that the focus should be on the skill sets and specific competencies of assigned staff," officials wrote in the proposed rules, "to provide the nursing care a resident needs rather than a static number of staff or hours of nursing care that does not consider resident characteristics." Nursing homes will still be required to report staffing levels, which Medicare officials said they will review for adequacy.

Do you work in a long-term care facility?  Do you have a loved one who is a resident of a nursing home? Tell us what you think can be done to improve the health and well-being of residents in the comments below.

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