Do you know that there were more than 9,800 public comments received during the public comment process of proposed rule published in July 16, 2016, prior to the New Final Rule for Requirement for Participation published in the Federal Register on October 4, 2016? Phase 1 of the Final Rule became effective November 28, 2016.
I read through the comments section, and one set of comments and response caught my attention. As noted above there were lots of comments that came from long-term care stakeholders, advocacy groups, consumers, etc., and the Centers for Medicare & Medicaid Services responded to those comments, and as well as utilizing some of the issues raised into formulating parts of the regulations. Below is that comment and response:
Comments: “A number of commenters responded to our request for comments in ways that suggest misunderstandings of either current requirements, or the proposed requirements. Notable misconceptions include: the belief that allowing residents to choose their own physicians will be something new; RN on the interdisciplinary team will be new; concerns that health and safety activities in LTC will have to be recreated; belief that complete care plan would need to be developed within 48 hours of admission; impression that new requirement are simply duplicates of the old; some commenters expressed concerns that CMS was unreasonably focused on regulating LTC facilities and not, other providers; and concerns that LTC facilities were “the most regulated industry in America”, and that ”the nuclear industry is less regulated” than the LTC facility industry.”
Response: “We (CMS) recognize that the proposed rule and this final rule are large, detailed documents, and that many individuals relied on summaries to learn about the proposed requirements. We understand that working professionals and family caregivers can be very busy, but we are concerned by some of these misinterpretations. Most of the misconceptions fell into three categories: Unfamiliarity with the old requirements, misunderstanding of the proposed requirements, or confusion about which facilities must meet the LTC requirements. The comments displaying unfamiliarity with the existing requirements are troubling to us. ….”
CMS’ views about the unfamiliarity of existing and proposed requirements by hard working professionals and family caregivers, and the fact that they are troubled by it, is a point well taken. All skilled nursing facilities and nursing facilities already have or should have staff development department or structure in place. Based on my experience and observations through the years, as a hands-on nursing home administrator, I can say that there are quite a few factors that impact the commitment and dedication to training, which in turn impact the level of staffs’ familiarity with regulations, which also impacts quality. Facilities have the tools to get the job done, and get their staffs adequately trained, so they become familiar with the regulations that guide the care and service they provide. Below are tips to help administrators and staff development directors.
How to encourage familiarity with LTC requirements
Facility leadership maintaining a commitment to staff development: The administrator and all facility leadership should have a vested interest in ensuring that staffs at all level become familiar with the long term care regulations.
Staff development / educational in-services should not be just the domain of the Director of Staff Development; it should be the responsibility of all leadership. All leadership should have accountability when their staffs do not show up for scheduled in-services.
Facility’s staffing on scheduled in-service days: There should be adequate staffing for planned in-service days. This mainly affects care areas such as nursing department. The staffing or scheduling coordinator should ensure that there is enough staff so staff are not pulled from in-services to cover patient/resident care, except of course for emergency situations.
Routine assessment of the staff’s educational needs: Director or designee should have routine assessment of the staff’s educational needs in addition to regulated mandated in-services. This will help determine the frequency of mandatory in-services such as resident rights, prevention of abuse; dementia care, clinical competencies such as wound management, head to toe assessment, etc.; in addition to the needs of the staff based on the clinical needs of the residents.
Staff development being an Integral Part of QAPI: Staff Development should be an integral part of Quality Assurance Performance Improvement (QAPI) program or Quality Assurance for now. Staff Development Director should report quarterly or monthly at the Quality Assurance or QAPI meetings, as to the status of staff attendance and participation in in-services. This will help the facility leadership keep track of the status of staff development.
Monthly general staff meetings: Most or all facilities have general staff meetings for all shifts, when Administrator and other leadership meet with the staff to receive and share information. The general staff meeting is another important avenue that should be utilized for brief educational presentations. During monthly general staff meetings, department directors can do a short presentation about parts of the regulations that relate to their departments. This provides opportunities for staffs to hear from different department directors, not staff development director only.
Nora Wellington, MBA, LNHA, Certified INTERACT Champion, is the CEO and founder of N Wellington Associates, a long-term care consulting company. She has more than 25 years experience as an administrator and she has authored two industry books on monitoring tools for regulatory compliance.