Changes to Surveyor Guidelines and regulations cover a number of topics including: Reasonable Person Concept, Training staff members and volunteers, staff interventions for Substance Abuse and Overdose, Trauma Informed Care, Smoking Areas, and Infection Interventionist training and hours.
Many more details on all of these topics are in LTCS Books’ long term care and nursing home care manuals listed on the left. Read more details about the October 24 changes.
Long term care facilities must develop and implement a baseline care plan for each resident within 48 hours of admission.
The guidelines state the 48 hour baseline care plan must include “the instructions needed to provide effective and person-centered care of the resident that meet professional standards of quality care,” including, but not limited to: initial goals based on admission orders, physician orders, dietary orders, therapy services, social services, and PASARR recommendation, if applicable.
According to the regulations, facilities may develop a comprehensive care plan in place of the baseline care plan if the comprehensive care plan meets all of the requirements for the baseline care plan outlined in the surveyor guidelines.
In order to assure all of the requirements of the guidelines are met, LTCS Books recommends that the facility develops and implements a comprehensive care plan within 48 hours of admission.
Baseline Care Plan Regulations
Complete Nursing Care Plans for Long Term Care
CMS Updated Surveyor Guidelines for Long Term Care Faciities
CMS recently announced it intends to issue new rules on a minimum staffing level requirement for long term care facilities within one year. The following CMS requirements remain in effect:
A long term care facility must have sufficient nursing staff with the appropriate skills to maintain the highest practicable physical, mental, and psychosocial well-being and safety of each resident, as determined by plans of care, and considering the number, acuity and diagnoses of the facility’s resident population.
A facility must provide on each day 8 consecutive hours of RN services and around-the-clock licensed nurse services, and must post in a location visible to all residents and visitors daily nurse staffing data giving the total number and type of nursing staff and the actual hours worked by shift.
Facilities must submit direct-care staffing information on RNs, LPNs, nurse aides, therapists, or other medical personnel based on payroll and other verifiable data to CMS via the Staffing Data Submission and Payroll-Based Journal (PBJ.)
CMS calculates the data submitted, and then for any facility reporting at least 7 total days in a quarter without any RN time, downgrades its Staffing Rating to 1 Star on the Nursing Home Compare site.
An April 7 CMS update outlined minimum regulatory requirements that providers must restore to protect residents’ health and safety.
Emergency Declaration Blanket Waivers ending May 7, 2022 include: Physician Visits and Delegation of Tasks, Clinical Records, Resident Groups, Quality Assurance and Performance Improvement Programs, and Discharge Planning.
Emergency Declaration Blanket Waivers ending June 7, 2022 include:
Training and Certification of Nurse Aides mandating that a skilled nursing facility may not employ anyone for longer than four months unless they meet the training and certification requirements under CFR §483.35(d).
In-Service Training requiring a nursing assistant to receive at least 12 hours of in-service training annually under 42 CFR §483.95(g)(1).
Update to COVID-19 Emergency Declaration Blanket Waivers
CMS will begin posting the following information for each nursing home on the Medicare.gov Care Compare website:
Weekend Staffing: The level of total nurse and registered nurse (RN) staffing on weekends over a quarter.
Staff Turnover: The percent of nursing staff and number of administrators that stopped working at the nursing home over a 12-month period.
This information will be added to the Care Compare website in January 2022 and used in the Nursing Home Five Star Quality Rating System in July 2022.