The Expanding Focus on Resident-Centered Care in Nursing Homes

Resident-centered care is hardly a new idea for those of us in the long term care industry, yet it’s one we have been hearing about much more recently. The term refers to the idea of promoting choices, purpose and meaning to your facility’s residents. One way this concept is promoted is through individualized care planning, where each resident’s wishes, desires and needs are taken into account and adapted as those desires change. Giving your residents autonomy is crucial to providing superior quality of care, and the regulators are circling the wagons with several initiatives to ensure that this is top of mind for you and your staff.

As you are aware, the Quality Indicator Survey (QIS) is being implemented – albeit slower than planned – across the United States. One of the key differences between the QIS and a standard recertification survey is the focus on interviews. The Resident Interview and Resident Observation forms, along with several other forms, have been updated as of March 6, 2013. From a surveyor’s point of view, these areas are ripe for finding deficiencies, as the residents themselves are a great resource for surveyors to glean information about the level care that is being provided to them. Using the available QIS forms is a great jumping off point for conducting your own resident interviews and observations to learn more about your residents’ individual needs and care plan appropriately.

If the QIS isn’t enough to make you think about the importance of listening to your residents, then there is always the looming Quality Assurance and Performance Improvement (QAPI) rule that’s being finalized. QAPI is a data-driven, proactive approach to improving the quality of life, care and services in your nursing home that requires you to formalize your systems and processes to help you achieve goals that improve these areas. Element 1 of the Five Elements of QAPI, “Design and Scope,” provides that your program should address systems of care and management practices, including resident choice, quality of life, clinical care and care transitions, so you need to think about what you are doing to give your residents choices. Element 3, “Feedback, Data Systems and Monitoring,” requires that you put systems into place (if you do not already have them) that help monitor care and services by drawing from multiple sources, including residents and family members. Effectively implementing QAPI in your nursing home means that you will need to communicate with residents, their families or legal representatives to include their input in process improvements. This group of non-staff is an excellent source of information on quality concerns.

Those two initiatives aren’t all the Centers for Medicaid & Medicare (CMS) has set forth to guarantee you are thinking about each resident and providing them with the ability to make choices and maintain their autonomy. The November 2012 updates to F-155 Advance Directives, F-309 Quality of Life and F-322 Feeding Tubes all ensure that the resident or family member / legal representative have the ability to make decisions on how they would like care to be provided to them, whether it is at the current time or when the resident is at end of life. Under F-155, your residents have the ability to initiative Advance Directives and clarify whether they would like specific treatments if necessary. F-309 mandates that residents who are approaching the end of life are made aware of that and that you work with them to ensure their preferences are met. F-322 is tied into these other tags by allowing the residents to decide whether or not they would want a feeding tube to be used if necessary.

CMS isn’t the only government group focusing on your facility and how you are providing your residents with autonomy. The Office of the Inspector General (OIG) has also listed some initiatives in its 2013 Work Plan that will drive the focus on resident-centered care. In FY 2013, the OIG expects to release its report on Medicare Requirements for Quality of Care. The focus of this report will be on care planning and how your facility is using the RAI instruments to develop individualized plans of care for your residents. Similarly, it will be reviewing the completeness of the MDS information submitted by LTC facilities, which is another key source for care planning. With the OIG reviewing how CMS and the State agencies are ensuring MDS data is being used, you can expect that CMS will be reviewing this data more intensely to see how you are using it to help with ensuring each resident receives the highest quality of care. You can see that the OIG is already shining a light on this initiative with its February 2013 report, “Skilled Nursing Facilities Often Fail to Meet Care Planning and Discharge Planning Requirements.”

The benefit of continual focus your skilled nursing facility will need to maintain to meet the requirements of all these initiatives is clearly not only to remain in compliance. Providing the highest care to your residents in a homelike environment will help with quality improvement, allow your residents and their caregivers to form closer bonds and assist with maintaining an interdisciplinary approach towards the care you are providing.

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