Nancy L. Gorman
Nancy L. Gorman

As growing numbers of Americans age and need extended care, long-term care organizations have sought to better meet both the healthcare and social needs of their residents. Those who reach the point in life where nursing home care is necessary do not want to live in an environment that feels like a hospital instead of a home.

Over the past several years, alternatives to institutional environments such as the Green House Project, the Pioneer Network and the Eden Alternative have all aimed to encourage genuine homes for the disabled elderly. And, with the Centers for Medicare & Medicaid Services’ recent call for a culture change in nursing homes, the focus on resident-centered care places a priority on residents’ rights.

CMS’ new rules will encourage long-term care organizations to improve the quality of residents’ lives by moving away from the institutional environment. For example, a resident’s preferences for a daily schedule should be respected. Also, institutional overhead paging systems, alarms and large nursing stations, and meals served on institutional trays, should be eliminated.

Standards support culture change

The Joint Commission’s enhanced standards complement CMS’ guidance, support the quality of life and quality of care in long-term care organizations, and embrace the culture change movement so needed across the long term care industry.

Consider the following Joint Commission standards that support this new thinking:

* Standard RI.01.06.05: The resident has the right to an environment that preserves dignity and contributes to a positive self-image.

In long-term care settings, the place where care is provided is also the resident’s home. Home is a place where residents feel safe; their possessions are secure and accessible. More importantly, the environment supports their independence and interests.nResidents can personalize their living space with pictures, photos, radios, furniture and afghans. It is important for the organization to support the unique needs and choices of each resident, recognizing that these needs and choices may change over time.

* Standard RI.01.07.05: The resident has the right to receive and restrict visitors.

The organization establishes visiting hours that accommodate the resident’s personal preferences.
This standard underscores that space must be provided for the resident to receive visitors in comfort and privacy. Residents also should have the right to refuse to communicate with visitors such as vendors, accreditation surveyors, representatives of community organizations and others. In addition, compliance with the standard requires that individuals who are permitted by law and regulation must be granted immediate access to residents.

* Standard RI.01.02.01: The organization respects the resident’s right to participate in decisions about his or her care, treatment and services.

Effective long-term care requires the involvement of residents and their families or surrogate decision makers, when necessary. Decision making is enhanced when residents know the goals of care, treatment and services; understand how various activities support care, treatment and services; and are informed about unexpected outcomes or issues. This involvement also helps prevent or resolve problems in care.

The Joint Commission maintains its focus on residents’ rights through its signature tracer activity. During the Resident Centered tracer, the surveyor shadows a resident during treatments, transportation, activities, therapy and meals. Resident and staff interactions are observed and residents are queried about their interests and whether or not staff allows them choices concerning their schedules.
The Joint Commission’s fresh approach to long-term care standards, effective January 2010, has eliminated non-essential requirements and created clearer, more objective wording. Like CMS’ guidance, Joint Commission standards aspire to an improved care environment and more choices for residents.

Nancy Gorman. M.S., RN, is field director, Surveyor Management and Development, The Joint Commission.