In a new S&C letter, “Update Report on the National Partnership to Improve Dementia Care in Nursing Homes,” CMS includes a report on the progress of the National Partnership, as well as information on what has occurred since it released the 2014 Interim Report on the CMS National Partnership to Improve Dementia Care in Nursing Homes Q4 2011- Q1 2014.
The new report, “Update Report on the Centers for Medicare & Medicaid Services (CMS) National Partnership to Improve Dementia Care in Nursing Homes: 2014 Quarter 2 – 2015 Quarter 3” includes information on the FY 2015 Focused Dementia Surveys that were conducted and outlines steps for the focused survey process going forward. The report for FY 2014, “2014 Final Report & 2015 Expansion Project – Centers for Medicare & Medicaid Services (CMS) Focused Dementia Care Survey Pilot can be found here.
FY 2015 Focused Dementia Care Surveys
- Expansion project was part of targeted effort by CMS to improve surveyor effectiveness in citing poor dementia care and the overutilization of antipsychotic medications. The initial pilot took place in FY 2014.
- States where surveys were conducted included: California, Illinois, Mississippi, Missouri, Nebraska and Texas
- All surveys were surveys of record, resulting in the citation of deficient practices and the use of standard enforcement remedies
- Facilities specifically chosen for the focused survey were selected through criteria provided by CMS
The good news is that overall, surveyors noticed positive changes on revisits to facilities that were part of the FY 2015 focused survey group. They found that the survey process helped to facilitate compliance with dementia care standards and quality of life practices. The survey teams that conducted a brief MDS review ahead of the survey felt that the sample selection process was simplified and surveyors who were accompanied by a pharmacist found that they were better able to identify unnecessary medication issues.
Surveyors noted that there was a lack of training on evidence-based dementia practices and acceptable prescribing regimes, which may have resulted in more identified deficient practices if the surveyors had been better trained. They also noted that facilities were underprepared regarding the process for the focused survey, including the availability of staff for interviews or the availability of information. That said, what deficiencies did the surveyors find? Let’s take a look:
- 60% of surveys cited F-309 Care of a Resident with Dementia
- 70% of surveys cited F-329 Unnecessary Use of Medications
- 57% of surveys cited both F-309 and F-329
- 7.5% of surveys included a G level (Actual Harm) or above
- There was a wide range in the number of deficiencies given by each state
- Other commonly cited tags for the Focused Dementia Survey include:
- F-248 Activities Meet Interests/Needs of Each Resident
- F-279 Develop Comprehensive Care Plans
- F-428 Drug Regimen Review, Report Irregularities, Act On Irregularities
- F-520 Quality Assessment and Assurance
Going forward, CMS notes that it will continue to review and analyze data related to enforcement activity, which is part of its FY 2016 – FY 2017 Nursing Home Action Plan, and will continue to conduct Focused Dementia Care Surveys across the country. Facilities selected for these focused surveys are ones that have continually high levels of antipsychotic medication use. One other key data point from the report is that CMS is “exploring potential unintended consequences” of trends such as the shift from prescribing antipsychotics to anxiolytics or sedative/hypnotics . . . just like one of April’s newly added Quality Measures.
Read CMS S&C letter, “Update Report on the National Partnership to Improve Dementia Care in Nursing Homes,” (Ref: S&C: 16-27-NH).
