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TheNEW NursingHomeRegulations:WhatDoResidents,Families&OmbudsmenNeedtoKnow?
PresentedbyRichardMollot,LongTermCareCommunityCoalitionwww.nursinghome411.org
+ AbouttheLongTermCareCommunityCoalition
n LTCCC:Nonprofitorganizationdedicatedtoimprovingcare&qualityoflifefortheelderly&adultdisabledinlongtermcare(LTC).
n Ourfocus:Peoplewholiveinnursinghomes&assistedliving.
n Whatwedo:n PolicyanalysisandsystemsadvocacyinNYS&nationally;n Educationofconsumersandfamilies,LTCOmbudsmenandother
stakeholders.
n CoalitionmembersincludeseveralLTCOmbudsmanPrograms,theCenterforIndependenceoftheDisabled,AARPNY,severalAlzheimer’sAssociationChapters,othersenioranddisabledorganizations.Alsoindividuals,includingombudsmen,whojoininourmissiontoprotectresidents.
n RichardMollot:JoinedLTCCCin2002.Executivedirectorsince2005.
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+ WhatWillWeBeTalkingAboutTODAY? 3
nBACKGROUNDo OverviewoftheNursingHomeSystem
o TheFederalNursingHomeLaw
nWHATISHAPPENINGNOW?o TheNursingHomeStandardsandChangesUnderway
o LTCCC’sProjecttoEducate&SupportFamilies,OmbudsmenandResidents…
+ TheNursingHomeSysteminaNutshell
n ThevastmajorityofnursinghomesparticipateinMedicaidand/orMedicare.
n InordertoparticipateinMedicaid/Medicare,afacilityagreestomeetthestandardsprovidedforinfederallaw.
n Statesmayhaveadditional protections,butnostatecanhavelessprotections.
n Federalprotectionsareforalltheresidentsinafacility,whethertheircareispaidforbyMedicare,Medicaidorprivatepay.
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n TheNursingHomeReformLaw(akaOBRA87)requiresnursinghomesreceivingfederalfundingtoconformtospecificstandardsofcare.
n Federallawrequiresthatevery nursinghomeresidentisprovidedthecareandqualityoflifesufficientforthemtoattainandmaintaintheirhighestpracticablephysical,emotional andsocial well-being.
n Thisiswhatwepayfor.
n Thisiswhatprovidersagreetoprovide.
n Thisiswhateveryresidentdeserves.
5TheNursingHomeReformLaw
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n Theemphasisonindividualized,patient-centeredcarewasintendedtoreducewidespreadproblemsinlong-termcarefacilities,includingabuseandneglect,andimprovequalityoflife.
n Importantly,thelawlaysoutspecificresidentrights,fromgoodcareandmonitoringtoaqualityoflifethatmaximizeschoice,dignityandautonomy.
n Inshort:EverynursinghomethattakesinanyMedicaid/Medicaremoneyagreesto– andispaidto– havesufficientstaffandappropriateservicestoensurethatalloftheirresidentsareabletoattainandmaintaintheirhighestpracticablewell-being.
6TheNursingHomeReformLaw
+ Question:
IftheNursingHomeReformLawissoGREAT,WhyaresomanynursinghomesBADplacestoliveandgetcare?
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+ Answer:
Thoughthelawsarestrongandthestandardsaregood,theycanonlymakeadifferenceinthelivesofresidentsiftheyareENFORCED.
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+ TheNursingHomeEnforcementAgenciesn USCMS.
o Thefederalagency,CMS,isresponsibleforpayingforMedicareandMedicaidservicesinevery settingnation-wide,fordevelopingstandardsforprovisionofthatcareandforensuringthatthosestandardsaremet.
o CMScontractswiththeStateAgenciestoperformoversightfunctions.n NYSDOH. TheStateSurveyAgency,responsibleformonitoringcareand
ensuringqualityinNYSfacilities.n NYSMFCU. TheMedicaidFraudControlUnit,housedintheNYSAttorney
General’soffice,alsohasanimportantrole.Byensuringthatpublic$$isspentonqualityservices,itcanholdnursinghomesaccountableforabuseandneglect.MFCUhasitsownabuseandneglectcomplaintline.
n NYSComptroller. TheComptrollerfocusesontheintegrityofpublicprogramsandpublicagencies.Becausemostnursinghomecareispaidforwithpublicfunds,theyhavealessdirect– butstillimportant– roleinensuringthatresidentsreceivedecentcare.
n NYSOMIG. TheOfficeoftheMedicaidInspectorGeneralalsohasaroleinassuringthatcareinnursinghomesandotherpublicprogramisprovidedsafelyandappropriately.
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+ TheNursingHomeEnforcementSystem:Structure
Payment&QualityAssurancesystemfornursinghomecare
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CMS
NYSDepartmentofHealth
NursingHomes
Residents
+LTCOmbudsmanProgram
WhiletheLTCOmbudsmanProgramdoesnothaveauthoritytopenalizeafacility,Ombudsmenaretheonly onesthereonaregularbasistomonitorcare&provideavoiceforresidents.Ombudsmenhaveacriticalroleinqualityimprovementandmakingsurethatresidentsareprotected.
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Monitor
Listen
Empower
Educate
Resolve
+PartII:PuttingitTogether
nWe’vediscussedthefoundationforgoodcare:o TheNursingHomeReformLawo OversightAgencieso TheLTCOmbudsmanProgram
nQuestions:o Howdoweovercomethechallengestoachievinggood
careandqualityoflife?o Howcanwestrengthenthefoundationtoachievethe
promisesoftheReformLaw:goodcare,sufficientstaffingandservices,dignity,goodqualityoflife?
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+ PuttingitTogether:TheStepstoQuality
Law
Regulations
Guidelines
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QualityCare
+ What’sHappeningNow?:NewFederalRegulations 14
1987NursingHome
ReformLaw
1991NursingHome
Regulations
2014CMS
AnnouncesPlanstoRevise
Regulations
Oct2016
NewRegulationsPublished
Nov2016PhaseI
Implementation
Nov2017PhaseII
Implementation
Nov2019PhaseIII
Implementation
Thegoalofthecurrentchangesistoimprovequalityandreduceresidentabuse&neglectbymodernizingthestepstoqualitycare.
+ WhatDoesThisMeanForUs?
n AlloftheRegulationsareChanging.For25yearseveryone– nursinghomes,surveyors,ombudsmenandadvocates– knewwhattheruleswereandwheretofindthem.Thatentirestructurehaschanged.
n AlloftheGuidelinesareChanging.Thefederalgovernmenthasissuedextensiveguidelinesovertheyearswhichprovidecriticalinstructionsonhownursinghomesaresupposedtocarryouttheregulatoryrequirementsandwhatsurveyorsneedtolookatwhentheyevaluateanursinghome.Thisisallbeingrevisedrightnow.
n AlloftheF-TagsareChanging. Whenasurveyoridentifiesaproblemincareorlivingconditionsinanursinghome,shecitesthenursinghomeusingasystemcalled“F-tags”– numbersthatcorrelatewiththeregulatoryrequirements.TheentireF-tagsystemischangingtoo.
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+ WhatCanWeDo?
BeasInformedasPossible.
n Now,andforthenextseveralyears,weexpectthattherewillbeagreatdealofconfusionandlackofawarenessamongnursinghomestaff,administrationandsurveyors.
n ItwillbeuptoUS toknowourrightsaboutqualityofcare,qualityoflifeanddignity.
nWE willneedtostrengthenourabilitytoprovideastrongvoiceforqualitycareanddignityateverylevel:o Residents&ResidentCouncilso Family&FamilyCouncilso LTCOmbudsmenStaff&Volunteerso Advocates&OrganizationsthatworkwithResidents&Families
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+ TheGoalofThisProject:ToProvideYOU WithKnowledge andResources toSupportYourResident-CenteredAdvocacyn Knowledge…
o FreemonthlytrainingprogramsforResident&FamilyCouncils,LTCOmbudsmenandthosewhoworkwiththem.
o Eachprogramwillfocusonanursinghomestandardthatisrelevanttoresidentcare,dignityorqualityoflife.
n Resources…o Foreverystandardwewillpostafreehandoutonourwebsitethat
youcanusenowandinthefuturetoknowyourrightsaboutaspecificissueorstandard.
o Presentationmaterialswillbepostedonthewebsiteforfuturereference.
o Weareredesigningourwebsite,www.nursinghome411.org withaLearningCenterforResidents,Families,Ombudsmenandthosewhoworkwiththem.
o TechnicalsupportforyourquestionsorconcernsonthequalitystandardsviaourNYSList-serveandemail.
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+ WhyShouldYou JoinThePrograms? 18
nManynursinghomesarealreadyconfusedaboutthenewstandardsofcareandwhattheyaresupposedtobedoingforResidents,FamiliesandOmbudsmen.
n ThechallengesforSurveyorstoidentifyandcitefacilitiesforabuseandneglectwillbecomeevengreaterasthenewsystemisimplemented.
n ItwillbeuptoUStoknowwhatourrightsareandwhatResidentshavearighttoexpectineveryaspectoftheircareandservices.
n ItwillbeuptoUS tomakesurethatResidentCouncils,FamilyCouncilsandLTCOmbudsmanProgramareequippedtoprovideastrongvoiceforResidents.
KnowYourRights!
KnowledgeisPower!
+ ComingUp 19
NextProgram:March21at1pm.
Topic:Resident’sRightsunderthenewregulations.§ What’snew?§ Howdoesthisaffectcare,
qualityoflifeanddignityforourresidents?
WeCan’tFightForOurRightsIfWeDon’tKnowWhatThey
Are.
+ [email protected] orcall212-385-0355 ifyouwouldliketo…
n Togetalerts&materialsforfutureprograms;
n Signupforournewsletterandactionalerts;or
n Joinourlist-serve,openonlytoresidents,families,LTCOmbudsmenandadvocatesinNYState.
YoucanalsojoinusonFacebook atwww.facebook.com/ltccc andfollowusonTwitter atwww.twitter.com/LTCconsumer.
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