New Nursing Home Rules Offer Residents More Control of Their Care

Mark has been a loving caregiver for his mother, Roberta, who has had Alzheimer’s for over five years. Roberta now needs more care than Mark can provide. Mark has spent lots of time and energy seeking quality options in long-term skilled nursing facilities, with “person-centered” care being of utmost importance to him.

Person-centered care is a holistic approach that focuses on quality-of-life, health, and well-being. Person-centered living encompasses care, services and meaningful engagement that is planned according to residents’ personal preferences, values, and goals. This approach honors each senior’s dignity, choice, self-determination, and individuality, which enhances quality-of-life and quality-of-care for seniors.

Recently, according to an article in the Washington Post, major changes have been made by the Centers for Medicare & Medicaid Services (CMS) to improve the care and safety of the nearly 1.4 million residents in the more than 15,000 long-term care facilities that participate in the Medicare and Medicaid programs. The new rules offer residents more control of their care, by making their care more person-centered. This is the most wide-ranging revision of federal rules for such facilities in 25 years.

Until now, a person’s care was decided by the nursing home staff, and the resident and/or his or her family was often told about what that care will entail, what will specifically be done, and who will do it. The new regulations, proposed late last year by Health and Human Services Secretary Sylvia Mathews Burwell, take effect in three phases. The first kicked in in November 2016.

Here are highlights of the requirements now in effect:
Plan of care: Residents and families must be involved in the process of writing a plan of care, which must be completed within 48 hours of admission.
Greater food choices: Residents are entitled to alternative meals and snacks … at non-traditional times or outside of scheduled meal times.
Roommate selection: Residents can also choose their roommates, which may lead to siblings or same-sex couples being together.

Visitor hours: Residents now have a right to receive visitors of their choosing at the time of their choosing, as long as it doesn’t impose on another resident’s rights. Facilities may only limit visits by non-family members based on “clinical and safety” requirements.

Better grievance procedures: Nursing homes must now appoint an official who will handle complaints and follow a strengthened grievance process. Decisions must be in writing.

Challenging discharges: “Residents can no longer be discharged while appealing the discharge. They cannot be discharged for non-payment if they have applied for Medicaid or other insurance, are waiting for a payment decision or appealed a claim denial. If a nursing home refuses to accept a resident who wants to return from a hospital stay, the resident can appeal the decision. Also, residents who enter the hospital have a right to return to their same room, if it is available. A state’s long-term-care ombudsman must now get copies of any involuntary discharges so the situation can be reviewed as soon as possible,” according to Susan Jaffe of the Washington Post.
Expanding protection from abuse: The definition of abuse now includes financial exploitation. Nursing homes are prohibited from hiring any licensed professional who has received a disciplinary action because of abuse, neglect, mistreatment or financial exploitation of residents.

Ensuring a qualified staff: Facilities must have enough skilled and competent staff to meet residents’ needs. There are also specific training requirements for caring for residents with dementia and for preventing elder abuse.
Note: Consumer groups had urged federal officials to set minimum staffing levels for registered nurses and nursing staff, but the industry had opposed any mandates and none were included in the final rule.

Better infection control: Facilities will update 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.

“With proper implementation and enforcement, this could really transform a resident’s experience of a nursing home,” said Robyn Grant, director of public policy and advocacy for the Consumer Voice, a national group that advocates for residents’ rights. When asked about the changes, CMS Acting Administrator Slavitt said, “The health and safety of residents of long-term care facilities are our top priorities. The advances will give residents and families greater assurances of the care they receive.”

At the Farr Law Firm, our mission is to protect seniors and their families by preserving dignity, quality of life, and financial security. Person-centered care ensures that 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. Person-centered care is aligned with our mission, and we applaud the Centers for Medicare & Medicaid Services (CMS) on these new regulations.

Affording Nursing Home Care

Quality of care is always the most important factor when it comes to our loved ones. Most of us are also concerned about the affordability of nursing home care. This is a legitimate concern, as nursing homes in the Metro DC Area 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 to begin Medicaid Asset Protection Planning. Please call us to make an appointment for an 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

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About Evan H Farr, CELA, CAP

Evan H. Farr is a 4-time Best-Selling author in the field of Elder Law and Estate Planning. In addition to being one of approximately 500 Certified Elder Law Attorneys in the Country, Evan is one of approximately 100 members of the Council of Advanced Practitioners of the National Academy of Elder Law Attorneys and is a Charter Member of the Academy of Special Needs Planners.