Ftag of the Week – F919 Resident Call System

This week’s Ftag of the Week on the CMSCG Blog is F919 Resident Call System which is part of the Physical Environment regulatory group. F919 was effective in Phase 1, but there is a Phase 3 requirement that will become effective in November.

F919 requires that nursing homes have adequately equipped communications systems to allow residents to call for staff assistance. The system must relay the call directly to a staff member or to a centralized location where staff are working, such as a nurses’ station. Beginning in Phase 3, this regulation also specifies that the call system must be at each resident’s bedside. Although CMS has proposed to change some of the RoPs and delay certain Phase 3 requirements, the requirement for the call system at the resident’s bedside is not one of the ones that a delay is proposed for, so if your facility does not have this in place, it’s time to start thinking about working on it.

Unlike some of the other deficiencies we have discussed under the Physical Environment regulatory group in the past couple of posts, F919 has been cited pretty frequently under the LTCSP, and has been used to cite multiple issues. Here are some sample citations:

  • An employee told surveyors that the call light system had not been working for some time. The surveyors decided to test it and pulled the Code Blue alarm in a resident room. The alarm light went on, but no sound was made, nor did the call system at the Nurses’ station show an alert. (Complaint – S/S: K)
  • A facility did not have cords attached to the call lights in common resident restrooms on multiple units. The Maintenance Director was asked about this and stated that residents would not be able to call for help if they fell. (S/S: F)
  • Another facility did not ensure its resident call system was working properly, “resulting in verbalizations of frustration, anger and a delay in care” for residents. A surveyor noticed a call light above a resident’s door and went to check on the resident. The resident stated that she had been waiting on the toilet for nearly 45 minutes for assistance and that staff had forgotten about her and it made her angry. Surveyors then observed the hallway where other call lights were on, and multiple staff walked past the doors without responding (S/S: F)
  • A resident without a call light was interviewed; he stated that he had given his call light cord to his roommate because the roommate’s was missing for several months. During this interview, the resident also stated it was easier for him to get out of bed and walk down the hallway than his roommate, so he had given him the call bell cord. Another resident was observed visibly wet with wet sheets and no call bel by a surveyor (S/S: E)
  • A surveyor observed a resident in bed without a call light near her, and that there was a hand bell on the bedside table, blocked by the privacy curtain and out of the resident’s reach when she was in bed. A CNA stated he did not know why there was no call light and did not know the resident was supposed to have a hand bell (S/S: D)

 Surveyors can easily observe whether a functioning call system is in place, if staff are responding or ignoring requests for help, and surveyors can certainly recognize if centralized alert systems are not functioning properly or not loud enough for staff to be notified. Staff need to ensure that residents have the ability to request help, whether it is in bed (Phase 3) or in a common bathroom. If there are issues identified with rooms lacking the appropriate equipment, maintenance needs to be notified to address this in a timely manner. Perhaps most importantly, call bell response times need to be monitored, as they are a frequent topic of resident complaints.

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