Ask the payment expert ... about regs vs. resident choice

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Ask the payment expert ... about the observation stay loophole
Ask the payment expert ... about the observation stay loophole

We are going through culture change and wonder if surveyors will be more lenient with regulations if we do something that is resident choice? 

In 2009, the Centers for Medicare & Medicaid Services published some new guidance for surveyors that can be found in Appendix PP of the State Operations Manual, available online. 

Those guidelines set expectations to improve residents' quality of life by allowing more choice and mandating that facilities recognize these choices. They allowed more flexible resident meal times and medication administration times, and allowed residents more choice in when they rise and go to bed. 

If your changes are in a quality of life area, you should not be cited. However, if the changes you are implementing are related to standards of practice or regulations, you may have a problem. 

For instance, a facility had medication administration times that were changed to morning, evening and hs (bedtime). Residents were receiving insulin whenever they wanted. The facility did not take into consideration the type of insulin or the negative effect that could occur by not giving insulin at regular times. They were cited with actual harm due to a resident whose blood sugar fluctuated.

Another facility signed out its medications only one time for each medication pass (not each medication). They had multiple medication errors and were cited by the state multiple times. They failed to follow acceptable standards of practice that the nurse recheck the medication packet or bubble pack after to make sure each medication was given as ordered. In taking a short cut, errors were made. 

The message here is, changing practices to accommodate resident choices is fine, but compromising standards of practice or not following regulations is not acceptable.