HHS Proposes to Improve Care for Nursing Home Residents

A proposal announced today at the White House Conference on Aging would make major changes to improve the care and safety of the nearly 1.5 million residents in the more than 15,000 long-term care facilities or nursing homes that participate in the Medicare and Medicaid programs. If finalized, unnecessary hospital readmissions and infections would be reduced, quality of care increased, and safety measures strengthened for the more than 1 million residents in these facilities.

“This proposal is just one part of the administration’s overall commitment to transform our health system to deliver better quality care and spend our healthcare dollars in a smarter way,” says HHS secretary Sylvia M. Burwell. “Today’s measures set high standards for quality and safety in nursing homes and long-term care facilities. 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.”

Many of the proposals build on improvements that nursing homes have already made since 1991, the last time these conditions of participation were comprehensively updated. This rule would bring these best practices for resident care to all facilities that participate in Medicare or Medicaid and implement a number of important safeguards that have been identified by patient advocates and other stakeholders, and include additional protections required by the Affordable Care Act.

Changes include:
• Updating 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.
• Making sure that nursing home staff is properly trained on caring for residents with dementia and in preventing elder abuse.
• Ensuring that nursing homes to take into consideration the health of residents when making decisions on the kinds and levels of staffing a facility needs to properly take care of its residents.
• Ensuring that staff members have the right skill sets and competencies to provide person-centered care to residents. The care plan developed will take the resident’s goals of care and preferences into consideration.
• Improving care planning, including discharge planning for all residents with involvement of the facility’s interdisciplinary team and consideration of the caregiver’s capacity, giving residents information they need for follow-up, and ensuring that instructions are transmitted to any receiving facilities or services.
• Allowing dietitians and therapy providers the authority to write orders in their areas of expertise when a physician delegates the responsibility and state licensing laws allow.
• Requiring nursing homes to provide greater food choice for residents while also giving flexibility for nursing homes.
• Strengthening rights of nursing home residents, including placing limits on when and how binding arbitration agreements may be used.

The Centers for Medicare & Medicaid Services (CMS) set out to revise the long-term care standards to meet the President’s Executive Order that all federal agencies identify rules that are obsolete or unnecessary and make proposals to “modify, streamline, expand, or repeal them.” The recommended reforms are being published in proposed rule CMS-3260-P, in the July 16, 2015 Federal Register.