Guest Columns

Selling fear: Are you buying?

Steven Littlehale
Steven Littlehale

The Oxford Dictionary defines “fearmongering” as an action of deliberately arousing public fear or alarm about a particular issue. Lately, it can be applied to a person, and even federal policy.

In an election year, it's a strategy the public often watches play out on the campaign trail and through the media.

Fearmongering is not a concept created by contemporary society, however. One could argue it was around well before we were told that if we didn't act a certain way, we would be struck by lightning.

While fearmongering has certainly played a major role in the 2016 presidential race, it's becoming more and more common in our own industry as well. In fact, as our industry digests and reacts to the Centers for Medicare & Medicaid Services' Consolidated Medicare and Medicaid requirements for participation final ruling, fearmongering has reared its ugly head in a big way.

Are you buying the hype? Don't. Seriously … don't buy it.

The dust has yet to settle on the final rule and there are already costly conferences, webinars and custom consulting packages popping up. Within a few months (or maybe weeks), we'll probably see a manual promising a “complete solution” and featuring either a smiling nursing home resident on the cover or a nurse with her arms crossed and an “I got this” smirk on her face. Aside from wasting time and money, I'm most concerned with the accuracy of these first-to-market offerings. Some of the brightest minds in our industry are still digesting the 700-plus pages of requirements.

This is the time for all of us to take a collective breath. I'm not suggesting we as an industry don't act, but rather we give due pause to such a significant and wide reaching policy — before committing resources.

When you do come up for air, consider this: CMS is not the nemesis. These new requirements are not bad, evil or otherwise designed to make your life miserable.

Setting aside the prohibition on the use of pre-dispute binding arbitration agreements, let's take an honest 300- or even 30-foot view and begin by asking ourselves if we've changed our own facility policy and procedures since 1991.

Are the beneficiaries we care for today different than those we cared for in the early '90s? And, has evidence-based practice evolved? Yes, and of course, yes again.

In the executive summary in the regulations, CMS presents a solid argument for the revisions – which will likely align with your honest answers to the questions I posed above. You've evolved professionally, revised care practices to reflect the needs of our changing residents, and modified policies and procedures accordingly.

Let me provide you with a few examples to support my position, which is that you've likely already met (or mostly met) these new requirements, particularly those due at the beginning of the three-year phase in process.

Quality Assurance Performance Improvement (QAPI) has been on your radar since President Obama signed the Affordable Care Act in 2010. You saw the inherent value of this tool, and evolved your QA programs to reflect this systematic data-driven approach to organizational improvement. You educated yourself, and your organization, and incorporated these concepts into your daily practice.

The “new” resident assessment requirements merely restate what was previously required. Yes, it uses more comprehensive language that reminds us to consider not only “understanding a resident needs, but also to understand their strengths, goals, life history, and preferences.” It then adjusts our language from “discharge potential” to “discharge planning” so as to encourage a shift in our thinking about resident preference and expectation — a practice that many of you already employ today.

And finally, comprehensive person-centered care planning adds a new requirement that you complete a baseline interim care plan for each resident upon his or her admission to the facility, within 48 hours. This care plan would include initial goals based on admission orders, physician orders, dietary orders, therapy services, social services and PASARR recommendations as appropriate.

Are any of these “new” guidelines all that different from what you currently do with your initial admission assessment? I suspect you already create a baseline plan of care.

OK, now let me remove my rose-colored glasses for just a moment to acknowledge that while these new requirements might seem reasonable and realistic, we have yet to know how these regulations will impact the survey process. I suspect that what is most likely behind the initial “kick in the gut” feeling is our concern regarding how surveyors will internalize the new regulations and enforce their actions.

CMS denotes that updated training will be provided to the surveyors on the new regulatory language, and implementation will be in three phases. This should help us understand and better prepare for the specific nuances of these new regulations.

Until then, breathe slower, and a little bit easier. Seek out trusted sources for education, like AHCA and LeadingAge. Keep your wallet in your purse or back pocket, and continue to rely on your data to make informed decisions for all in your care today, and those who will be in your care tomorrow!

Steven Littlehale is a gerontological clinical nurse specialist, and executive vice president and chief clinical officer at PointRight Inc.

Guest Columns

Guest columns are written by long-term care industry experts, ranging from academics and thought leaders to administrators and CEOs.

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