Is it me or sometimes do the wide interpretations within the State Operations Manual (the dreaded “RED book”) make you want to question your entire existence? I mean, we’ve been working so diligently toward Culture Change and the true meaning of person-centered care. Nationally, I thought we were making headway. But nooooooo.

For the most part, people seem to understand that person-centered care (PCC) seeks to eliminate the assembly line approach to care and embraces a philosophy of residents as individuals. It seeks to improve quality of care and quality of life for residents. PCC leads to a more satisfied life, means residents are given choices and are able to make decisions, requires staff to alter work routines to accommodate resident preferences, and requires staff to have relevant knowledge and decision-making authority.

We also now know that PCC is based upon a fundamentally different perspective then where we began, which places particular value on an individual’s right to make decisions concerning every aspect of his or her life, even if risk is involved.

According to regulations from the Centers for Medicare & Medicaid Services, the resident has the right to: choose activities, schedules, food/beverages, and healthcare consistent with his or her preferences and interests; make choices about aspects of his or her life in the care community that are important to them; and participate in care planning — and even refuse treatment.

So why is it, when we allow residents their rights, and truly apply PCC — you know, do our due diligence and weigh risks versus benefits while doing our hardest to mitigate risk etc. and document the heck out of everything — our state surveyors can come in and say that “protecting” the resident in their opinion is in the best interest for the resident? And then they cite high-level deficiencies against the facility. Huh? Is it just me? 

CMS says give them the right even if it carries risk. Take the resident who has swallowing issues but still wants a regular diet, as the person feels this is a HUGE quality of life issue for them.

So you have a care team meeting with the attending practitioner, resident, authorized decision-maker etc. All agree to allow the resident the right to have a mostly regular diet, eliminating high choke hazard foods. All staff are trained on choking precautions, the diet is carefully planned to mitigate risk, everyone is happy.

Then the state walks in and says the facility is harming the resident with the potential for severe harm. And since you have quite a few residents with swallowing deficits, surveyors say there is a potential to harm a number of residents.   

Now you just want to smash your head against a wall. Or perhaps wonder if there is a good antipsychotic for the schizophrenia of the regulations. Yeah, I know: “Don’t go there!”

Just keeping it real,

Nurse Jackie

The Real Nurse Jackie is written by Jacqueline Vance, RNC, CDONA/LTC, a 2012 APEX Award of Excellence winner for Blog Writing. Vance is a real life long-term care nurse. A nationally respected nurse educator and past national LTC Nurse Administrator of the Year, she also is an accomplished stand-up comedienne. She has not starred in her own national television series — yet. The opinions supplied here are her own and do not necessarily reflect those of her employer or her professional affiliates.