Current Activities in Longterm Care
Kate Lynch, Editor
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CMS announces its “2007 Action Plan for Further Improvement
of Nursing Home Quality”

Will ADs see a big increase in their responsibilities?

By Bill Freiberg, Publisher

The Centers for Medicare and Medicaid Services (CMS) has announced a major “Action Plan”
designed to improve…and equalize…quality of care standards throughout the nation’s nursing
The 38-page document contains a lot of major new changes that the CMS expects to impart on
nursing homes in order to “provide reliable care of consistently high quality.”
As per usual, though, enforcement of any new guidelines and initiatives is a key factor as to
whether or not any new CMS rules are followed by nursing homes.
Recently, members of Congress and others have complained that standards and enforcement
vary far too much by state and that more states’ survey activities need to be brought more in
line with CMS nursing home standards. And their new “plan” may be a part of that process,
depending upon how CMS enacts and enforces this new initiative.

Payment schedules may differ according to quality of care

When CMS launched its new Activity and Psychosocial Outcome Severity guidelines last year,
many professionals started watching closely to see how strictly those new rules were enforced.
Reason: They were so comprehensive and detailed, and required so much major change in
how nursing homes handled daily activities of individual residents, that they could require
major budget changes at many facilities to even begin to accomplish.
In analyzing the details of these new guidelines, it became obvious that in order to even begin
to comply, activity directors would soon become among the most significant members of the
nursing home staff, with sometimes major budget increases in order to do the job. Otherwise,
the home would risk not being in compliance.

The big question: How tough is enforcement?
Whether or not this is occurring, we’re not sure. Current Activities hopes to explore this
situation in future editions. However, as we’ve pointed out many times, it’s the strength of
enforcement of the survey inspections that makes all the difference.
And we’ve heard reports from various ADs varying from “nothing has changed” to “we’ve had
to enact big changes.” And the difference is apparently largely on how different states enforce
the new CMS rules.
Apparently, CMS is finally starting to take all this seriously and will soon start insisting on a
coordinated enforcement of all its rules throughout all states and all nursing homes.  At least,
this is what their new Quality Initiative seems to insist on.
And… if seriously implemented… it could cause ADs everywhere to eventually see a major
boost in their importance and budgets, for they are the ones who are at the center of much of
these new “quality of life” rules.  

The plan

Here are some of the highlights of the plan:
Substantial improvement in effectiveness of nursing home surveys, standards and
enforcement of regulations. The CMS says it will undertake more than 14 initiatives this year in
this area, including improvement of investigations of complaints against nursing homes.
As we’ve reported in past issues of Current Activities, some members of Congress have asked
the CMS to substantially strengthen its survey process, as they feel it’s often too lax, and
complaints and problems are not always equally enforced among the states.
Quality improvement. The CMS says it will initiate a quality improvement program in a number
of areas, including reduction of restraint use and the overall reduction of pressure sores.
Culture change in nursing homes to emphasize residents as individuals. This, says the CMS,
means that each nursing home needs to “respect each nursing home resident in order to
provide individualized care that best enhances each person’s quality of life.”
The CMS says it will “encourage facilities to change outdated practices, to allow residents
more input into their own care,” and also encourage staff to “serve as a team that responds to
what each person wants and needs.”

Staff encouraged to serve as a team that
responds to each resident as an individual

This initiative, if enforced, would certainly strengthen compliance with the new CMS Activities
and Psychosocial Assessment Guidelines and dramatically increase the importance…and
budgets…of many activity director programs, since they’re at the center of this initiative.
Improve the coordination of CMS activities with all its “partners,” including the state survey
agencies.  This may result in more close alignment and coordination of surveys and
enforcement among all the states…which is something Congress has asked CMS to
Study the possibilities of exerting the CMS’ massive “purchasing power” with nursing homes as
a method of “exerting leverage to insist on basic levels of quality care.” In other words, the
CMS may pay for nursing home services on the basis of whether or not that home is providing
quality care, according to CMS standards.
The CMS suggests that payment schedules may differentiate between excellent, mediocre and
poor-quality care.
If enacted, this could be a powerful tool to enforce the quality of care regulations and force
many more nursing homes to enact them in their facilities.
We’ll keep you informed as all this rolls out, and see if the CMS is finally going to enforce major
changes in nursing homes…and overall improvement of activities of daily living and quality of
life issues for residents everywhere. Stay tuned.

Current Activities subscribers can get a copy of the entire 38-page plan by logging in to
Activity Pro-Online and downloading the “CMS 2007 Action Plan.”
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