Page 5 - Regulatory Support for Culture Change - 2018 update

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Porch Swing SeriesTM Culture Change Workbooks
©Action Pact, Inc.2005-2006
Regulatory Support for Culture Change
Discover how OBRA ’87 and its regulations support culture change and which regulations to bear in mind regarding common culture change practices.
Does OBRA support culture change?
Many wonder how they can embark on a culture change journey and remain compliant with federal and state regulations. While some may find it surprising, culture change is not only supported by the OBRA ‘87 regulations, but it actually em- bodies what the writers of OBRA ’87 intended.
As you read this workbook, place yourself in the role of a state long term care surveyor while the most common culture change practices and the regulations that pertain to each are discussed.
Exercise:
To begin, what regulations do you feel stand in the way of culture change? Brainstorm on your own or with a team. Which regulations come to mind as barriers to culture change?
Some history
Part of the background of our current long term care regulations, or OBRA ’87, stems back to 1973 and a young 15-year- old named Michael Patrick Smith. Michael had muscular dystrophy and his mother could no longer care for him at home. She found herself forced to make the heartrending decision to move him into a nursing home as there were no other
options in 1973. She found a Denver nursing home that served younger clients, but conditions there were horrible. In 1975, Michael, with the help of Activity Director Wade Clark, contacted Legal Aid. Attorney John Holland represented the young nursing home residents in a class action suit against both the Colorado state government and the federal government, citing that conditions in nursing homes were deplorable and unlivable.
In 1978, the Colorado state government joined the lawsuit against the federal government. Why did the state of Colorado take this step? It had to do with the “ownership” of the regulations. Any nursing home certified to receive payment by Medi- care and/or Medicaid is held accountable to the federal regulations and the federal survey process. Surveys in the 1970s were process-oriented, not outcome-oriented. This meant surveyors spent the majority of their time holed up in a room reviewing policies and procedures, job descriptions and staff qualifications. Thus, Colorado made the case that it was not their survey or regulatory process, they were just following instructions from the federal government.
When Colorado joined the lawsuit, the Executive Director of the Colorado Department of Health, Anthony Robbins, stated, “The federal LTC enforcement system... is in my opinion an invitation to mistreat residents while ostensibly operat- ing within the law... In the state’s experience, the present system simply does not guarantee the optimal medical, nursing, and psychosocial care...which each resident requires.”