CMS published Advance Guidance for the Revisions to the State Operations Manual (SOM), Appendix PP- Guidance to Surveyors for Long-Term Care (LTC) Facilities and Chapter 4 on July 3, 2014.
Revisions made to Appendix PP include:
Labeling of Drugs and Biologicals/Storage of Drugs and Biologicals – F281
Electronic Signature Guidance – F278
Exceptions to the Observation Requirement When Determining Significant Medication Errors – F332
Physician Delegation of Tasks – F387
Use of Insulin Pens, Safe Use of Single Dose/Single Use Medications to Prevent Healthcare-associated Infections, Point of Care Devices, Laundry and Infection Control – F441
Surveying Facilities that use Electronic Health Records – F514
Highlights of state Operations Manual Revisions July 2014
New dementia care surveyor guidelines were released by CMS March 24, 2014.
The guidelines focus on basic quality measures and dementia care principles: Person-centered care, quality and quantity of staff, thorough evaluation of new or worsening behaviors, individualized approaches to care, critical thinking related to antipsychotic drug use, interviews with prescribers, and engagement of the resident or representative in decision-making
Dementia Care in Nursing Homes F309 and F329
Long term care Restorative Nursing programs will see some big changes with the expansion of Medicare to cover Maintenance Therapy.
“Coverage of skilled nursing and skilled therapy services does not turn on the presence or absence of a beneficiary’s potential for improvement, but rather on the beneficiary’s need for skilled care.” CMS announced this week.
“Skilled care may be necessary to improve a patient’s current condition, to maintain the patient’s current condition, or to prevent or slow further deterioration of the patient’s condition. The concept of skilled therapy services can similarly involve not only services that are restorative in nature but, if certain standards are met, maintenance therapy as well.”
Maintenance Therapy is justified, says CMS, to prevent or slow a decline in condition.
Previous standards required that skilled nursing services result in an improvement to a resident’s condition to qualify for Medicare reimbursement.
Maintenance Therapy and Restorative Nursing Manual Updates to Clarify Skilled Nursing Facility (SNF), Inpatient Rehabilitation Facility (IRF), Home Health (HH), and Outpatient (OPT) Coverage, Department Of Health And Human Services, Centers for Medicare & Medicaid Services, Implementation Date: January 7, 2014
FAQ: Medicare Beneficiaries May See Increased Access To Physical Therapy Or Some Other Services, Kaiser Health News
As the demand for caregivers in long term care increases, fewer people are drawn to caregiver positions. The ratio of twenty residents to one CNA is now common, preventing any possibility of adequate care, job satisfaction, or staff retention.
“More than 1.3 million new paid caregivers will be needed to meet demand over the next decade,” according to a recent New York Times article.
The article also cites low wages and Medicare / Medicaid funding deficits as factors contributing to the problem.
This critical situation is not being acknowledged or addressed by government agencies. The Center for Medicare Advocacy states in a recent report that “the federal enforcement system cites very few facilities with staffing deficiencies and often does not impose any financial penalties, even when it finds that facilities do not have sufficient staff.”
A Shortage of Caregivers, New York Times Article
Center for Medicare Advocacy Report