Medicare seeks to rate homes on life quality

In what is being described as a “groundbreaking” shift, the Centers for Medicare & Medicaid Services has added quality-of-life and environment standards to the list of factors that nursing home inspectors (known as surveyors) should be looking at in their reviews.

CMS issued new guidance for nursing home surveys, to be applied effective last June 12, that includes a sharpened focus on resident rights in these key areas:

The new guidance is consistent with the tenets of the nursing home “culture change” movement, which industry leaders and policymakers in Rhode Island have strongly embraced for several years now, but which has not yet fully taken hold across the state.

A major proponent and expert in the field is Quality Partners of Rhode Island, a nonprofit in Providence that oversees nursing home quality improvement work for the state but has also advised CMS on a national level.

Marguerite M. McLaughlin, a senior program administrator at Quality Partners who has led culture change efforts in Rhode Island, said the CMS guidance is “great news” and a recognition of the value of work that some homes in the state, such as the St. Elizabeth Community, have been involved in for as long as 15 years.

“It’s not something new – it’s something we’ve been waiting for the federal government to respond to,” she said. Quality Partners actually led a year-long pilot project with 250 nursing homes to show the value of such efforts, she noted, and three years later, the participating homes still continue to show improvement.

The new guidance “takes into account a world of stuff that hadn’t ever been considered before,” McLaughlin said, and that makes a real difference in residents’ health – such as the ability to sleep as late as they want, rather than being forced to get up at 7 a.m.

“It’s the science we all knew,” she said, “but people were getting us to count all the other stuff. If nothing else, this creates a greater awareness that there’s another way to look at this. and that we need to include the residents’ voice.”

Currently, nearly 1.5 million individuals live in about 15,800 Medicare-eligible nursing homes across the country on any given day, and about 3 million people will spend some time in a nursing home each year.

“These groundbreaking revisions matter in the daily lives of people who live in the nation’s long-term care facilities,” said CMS Acting Administrator Charlene Frizzera. “The improvements in the guidance are intended to support efforts underway to transform nursing homes into environments that are more like their homes through both environmental changes and resident-centered caregiving.”

The new guidance also urges nursing homes to “de-institutionalize” their physical environments by making changes such as eliminating meal trays, avoiding noise from overhead paging systems and alarms, and getting rid of large nursing stations.

But a home-like environment isn’t just about physical changes, the guidance notes, but about “person-centered care,” emphasizing individualization, relationships, and a psychological environment that welcomes each resident and offers comfort.

Furthermore, the guidance notes that residents should be able to make choices about such things as daily waking, eating, bathing, and going to bed at night.

CMS inspects nursing homes periodically to ensure they meet the federal regulations requiring that each resident receive good quality care in a home that also provides good quality of life. The new guidance notes that “many facilities cannot immediately make these types of changes, but it should be a goal for all facilities that have not yet made these types of changes to work toward them.”

The full document is available at www.cms.hhs.gov.