Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency
The Requirements of Participation raised the bar for the nursing home industry. The 700 plus page document defines the criterion for Quality. That is, Quality of Care and Quality of Life.
The concept of person-centered care is evolving into a standard versus a notion. Healthcare Providers are re-thinking the historical service delivery model and inspecting the mechanism for change.
The below narratives are taken directly from the State Operations Manual Appendix PP. (Definitions - §483.5)
Person-Centered Care means to focus on the resident as the locus of control and support the resident in making their own choices and having control over their daily lives. Control over choices, such as:
- clothing, and
- privacy during visits,
- privacy during treatments;
- opportunities to engage in religious, political, civic, recreational or other social activitie
Quality of Life is a fundamental principle that applies to all care and services provided to facility residents. Each resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, consistent with the resident’s comprehensive assessment and plan of care.
- sense of well-being
- level of satisfaction with life
- feeling of self-worth
- sense of satisfaction with oneself,
- sense of satisfaction with the environment,
- sense of satisfaction with the care received,
- sense of satisfaction with the accomplishments of desired goals,
- and control over one’s life.
It is the facility’s responsibility to create and sustain an environment that humanizes and individualizes each resident’s quality of life by:
- Ensuring all staff, across all shifts and departments, understand the principles of quality of life, and honor and support these principles for each resident; and
- Ensuring that the care and services provided are person-centered, and honor and support each resident’s preferences, choices, values and beliefs.
Facilities must create and sustain an environment that humanizes and promotes each resident’s well-being, and feeling of self-worth and self-esteem. This requires nursing home leadership to establish a culture that treats each resident with respect and dignity as an individual, and addresses, supports and/or enhances his/her feelings of self-worth including personal control over choices, such as mealtimes, activities, clothing, and bedtime; privacy during visits, and treatments; and opportunities to engage in religious, political, civic, recreational or other social activities.
Facility leadership must be aware of the culture that exists in its facility and may use various methods to assess the attitudes and values prevalent amongst staff. These methods include, reviewing complaints or grievances, which could reasonably impact a resident’s quality of life, or allegations of abuse, neglect or mistreatment. To identify whether staff supports each resident’s quality of life, leadership should observe and evaluate verbal and nonverbal interactions between staff and residents. Negative observations could include staff actions such as the following:
- Verbalizing negative or condescending remarks, or refusing to provide individualized care to a resident due to his/her age, race, or cognitive or physical impairments, his/her political or cultural beliefs, or sexual preferences;
- Dehumanizing an individual through verbal and nonverbal actions such as talking to others over a resident without acknowledging his/her presence, treating the resident as if he/she were an object rather than a human being, mistreating, or physically, sexually or mentally abusing a resident.
These types of staff actions and attitudes do not recognize nor value the individual. An individual’s life experiences, values, needs, choices and relationships must not be diminished, to the extent possible, due to admission to a nursing home. Treating a nursing home resident in any manner that does not uphold a resident’s sense of self-worth, dignity and individuality dehumanizes the resident and creates an environment that perpetuates an unhealthy, unsafe attitude towards the resident(s).
To achieve a culture and environment that supports quality of life, the facility must ensure that all staff, across all shifts and departments, understand the principles of quality of life, and honor and support these principles for each resident and that the care and services that are provided by the facility are person-centered, and honor and support each resident’s preferences, choices, values and beliefs.
Example of Non-Compliance
On interview, dietary staff stated they did not have the time to prepare a special diet for this one resident, and stated to the surveyor, “They should have thought of that before they came to this country.” Additionally, the dietary staff reported that he/she was not aware of the dietary requirements of this resident’s religion. An interview with the consulting dietitian revealed that he/she was not aware that this resident had been admitted to the facility, and she agreed that the menu did not meet this resident’s religious preferences.
Review of the resident’s care plans revealed that there was no identification of this resident’s preferences or dietary requirements related to her religion.
As the result of cumulative effect of the noncompliance identified, this resident suffered loss of religious and cultural identity, had ongoing feelings of extreme sadness and humiliation, and expressed a wish to die.
These excerpts from the guidelines are compelling. The industry is on high alert as the baby boomers demand excellence in Quality of Life and Quality of Care.
Harmony Healthcare International (HHI) is available to assist with any questions or concerns that you may have. You can contact us by clicking here. Looking to train your staff? Join us in person at one of our our upcoming Competency/Certification Courses. Click here to see the dates and locations.
Source: State Operations Manual Appendix PP
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