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Proposed LTC Regs: Competency-Based Staffing

One proposed regulation for nursing facilities addresses “sufficient” staffing requirements. In an effort to create an environment where the focus is person-centered care, CMS is trying to create a flexible model that would ensure residents receive with the highest level of care. In our post on the Facility Assessment, we noted how that assessment data would become the reference point for many other requirements, and staffing is no exception. There has been a lot of controversy over staffing hours, whether it is negative media coverage of nursing homes or the effort by CMS to implement the Payroll Based Journal for staffing data.

CMS maintains that while facilities can have sufficient numbers of staff, quality may not improve if staff do not have the skills and competencies to provide high quality care. Therefore, it has proposed that the focus should be on these areas as opposed to a static number of staff. A static staffing level does not take into account the resident characteristics and does not ensure competent staff are providing care. Instead, the proposed regulations use the Facility Assessment as a guide to provide a different means for calculating staffing. Here are some areas that could be affected:

  • Nursing Services – CMS proposes that a competency requirement is used for determining sufficient nursing staff based on the Assessment, which includes specific data on the resident population including acuity, range of diagnoses and the number of residents.
  • Behavioral Health Services – New emphasis has been placed on Behavioral Health Services, and a competency requirement would be included here as well. The proposed regulations would require staff to have the “appropriate competencies and skills” to provide behavioral health care and services. This would be a requirement for caring for residents with mental and psychosocial illnesses and for ensuring that non-pharmacological interventions are being utilized.
  • Food and Nutrition Services – The proposed regulations would require that facilities have staff that have the appropriate competencies and skill sets to carry out the functions of Dietary Service, taking into consideration resident assessments, individualized resident care plans (including diagnoses and acuity) and the number of residents in the facility.

To assist with its competency-based approach to staffing, CMS has also proposed a set of training topics for staff to complete, including:

  • Communication
  • Resident Rights and Facility Responsibilities
  • Abuse, Neglect and Exploitation
  • QAPI & Infection Control
  • Compliance and Ethics
  • In-Service Training for Nurse Aides on Dementia Management and Resident Abuse Prevention training
  • Behavioral Health Training

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