On Monday, July 16th, the Consumer Voice submitted recommendations to the Centers for Medicaid and Medicare Services (CMS) in response to CMS’s request for input regarding revisions to the Conditions of Participation (these are technically called the Requirements of Participation – RoPs - and are the federal nursing home regulations). The federal rules were promulgated to implement the landmark Nursing Home Reform Law. Both the law and the rules have played an integral role in helping to protect and ensure quality of care and life for residents over the past twenty-five years.

CMS is conducting a review of the RoPs pursuant to presidential Executive Order 13563, “Improving Regulations and Regulatory Review” issued on January 2011 and a more recent Executive Order, “Identifying and Reducing Regulatory Burdens” released in May 2012. Both orders direct federal agencies to review their regulations and emphasize reducing the burden to providers.

At the end of May of this year, CMS notified the Consumer Voice of the opportunity to submit suggestions for revisions to the regulations. Over a period of six weeks, the Consumer Voice convened a workgroup of key long-term care advocates and requested comments from its network. The Consumer Voice recommendations reflect the outstanding feedback we received and focus on ways in which the regulations could be strengthened and improved, such as requiring a staffing standard for direct care staff and a registered nurse eight hours a day, seven days a week.

CMS has stated that the agency is looking for ways to reduce the burden to nursing home providers, make the rules person-centered, ensure the regulations support quality initiatives such as the Quality Assessment and Performance Improvement program, and modernize the RoPs. There is a strong focus on reducing burden; on a CMS Open Door Forum held July 12 a CMS official stated that reducing burden was “the big ticket item.” CMS’s recent revision of the Conditions of Participation for hospitals, which eliminated a number of federal standards and deferred to the states on many issues) sets a worrisome precedent for CMS’s review of the Requirements of Participation for long-term care facilities.

In its letter to CMS, the Consumer Voice expressed strong opposition to any changes that would weaken the current nursing home regulations and supported revisions that would improve residents’ quality of care and quality of life, promote person-centered care, and further protect residents’ safety and well-being. The Consumer Voice also urged CMS to conduct any review that is undertaken using an unrushed, transparent and inclusive (multi-stakeholder) process.

The Consumer Voice will continue to closely monitor any actions the agency may take on this matter and remain a vocal opponent of any proposed changes to the Requirements of Participation that would harm residents’ care, safety, or quality of life. To read the Consumer Voice’s recommendations submitted to CMS on these regulations, please click here.

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The Consumer Voice is saddened by the passing of Bob Bronaugh. Bob Bronaugh was a dedicated nursing home advocate for over 13 years and longtime member of the Consumer Voice. Bob was Co-President of the Manor Care Chevy Chase, Maryland Family Council, and with his family council, was instrumental in having a Family Council Bill passed in Montgomery County, which led to the passage of a Maryland Family Council Bill in 2004. Bob also served as the Vice Chair and a Board Member for state-wide advocacy group Voices for Quality Care. With his work with Voices, he helped in the formation of new family councils in Maryland nursing homes. In addition, he served on the Maryland Department of Health & Mental Hygiene’s Community Choice Advisory Group and was a member of the State Workgroup, which crafted the regulations for emergency preparedness in nursing homes. He also served as the consumer representative on the Advancing Excellence in America’s Nursing Homes’ Maryland LANE Steering Committee. Bob devoted countless hours to researching corporate ownership of Maryland’s long-term care facilities and presented on this topic at the 2008 and 2009 Consumer Voice annual conferences. Bob’s commitment to nursing home advocacy will be remembered.

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Join the Pioneer Network for their webinar series on using the MDS 3.0 as an engine for high quality individualized care. Part 8 of the webinar, “MDS and QAPI: A High Involvement Approach,” was held last week. The materials for this webinar are available on the Pioneer Network’s website. The next webinar in the series, “Individualizing Care and Environments: Non-pharmacologic Interventions Instead of Anti-Psychotic Medications,” will be held Thursday, September 20^th at 2:00pm EST. This webinar will feature G. Allen Power, MD, Eden Mentor at St. John’s Home in Rochester, NY, and Clinical Associate Professor of Medicine at the University of Rochester. Dr. Power will explain how to use everyday assessment and care planning within care teams to learn about residents’ routines, recognize what they are communicating when they express anguish, and lessen their anguish rather than mask it with medications.

For more information and to register for the upcoming webinar, visit the Pioneer Network’s website.

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This past Monday a member of the Consumer Voice staff attended a meeting for the National Coalition on Mental Health & Aging. During the meeting attendees listened to a briefing by Dr. Dan Blazer, Chairperson of the Institute of Medicine Committee on the Mental Health Workforce for Geriatric Population. Dr. Blazer discussed a new study done by the Institute of Medicine, titled “The Mental Health and Substance Use Workforce for Older Adults.” The study concluded that at least 5.6 million to 8 million – nearly one in five – older adults in America have one or more mental health and substance use conditions, which present unique challenges for their care. Unfortunately, the number of individuals working in or entering fields related to geriatric mental health/substance use is disproportionately small.

Research shows that effective delivery of mental health/substance use services to older adults requires these essential ingredients: 1) systematic outreach and diagnosis; 2) patient and family education and self-management support; 3) provider accountability for outcomes; 4) close follow-up and monitoring to prevent relapse. In the study the Institute of Medicine urged Congress to fund the National Health Care Workforce Commission, which was authorized under the Affordable Care Act, to serve as a national resource that focuses on evaluating and meeting the need for health care workers. Central among the commission’s top priorities should be identifying, developing, and refining methods to improve recruitment and retention of geriatric mental health/substance use personnel – and to build a workforce that reflects the diversity of the older adult population that it serves.

The study concludes by stating that the breadth and magnitude of the problem have grown to such proportions that no single approach, nor a few isolated changes in different federal agencies or programs, can adequately address the issue. What is needed is a focused and coordinated action by the Department of Health and Human Services, Centers for Medicare & Medicaid Services, Health Resources and Services Administration, National Institute on Drug Abuse, National Institute on Mental Health, and the Substance Abuse and Mental Health Services Administration.

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Consumer Voice Director of Public Policy Robyn Grant was recently quoted in a New York Times article depicting the troubles often faced when families have to hire home caregivers. There are many quality agencies that provide skillful, quality caregivers, but there are also agencies that are only out to get a profit.  Ms. Grant outlined several potential problems with home caregivers such as financial exploitation and theft and diversion of prescription drugs stocking older peoples’ medicine cabinets. She also offered some ways that families can protect their loved ones. For example, if the agency is Medicare-certified or licensed by the state, consumers likely have some additional protections.

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“This is America, isn’t it? We do some of the most important work a person can do. We are helping to improve human lives, and we cannot even afford to feed our families. That’s just wrong.” That’s what home care worker and Direct Care Alliance (DCA) Board Chair Tracy Dudzinski said about the fact that she and her fellow home care workers are not entitled to minimum wage and overtime pay under the federal Fair Labor Standards Act (FLSA).

DCA and its allies have created a petition urging the Department of Labor to extend FLSA protections to home care workers NOW. Please join us in signing it. Tell DOL to do the right thing by these important workers.

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The Joint Commission is in the process of re-inventing its Long Term Care Accreditation Program. The new approach will replace the current long term care accreditation product and will focus on the most critical issues supporting safety and quality of care for patients and residents of nursing homes. The Joint Commission is asking for comments on this new approach via an online survey available until Monday, August 13^th.

Take the online survey.

You can also participate in several conference calls to give feedback. The calls will occur between 9:00am and 6:00pm EST on August 2, 3, 9, or 10. Email your first and second choice of a preferred date and time to Jennifer Tarpey at jtarpey@jointcommission.org.

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