Page 49 - The Deep Seated Issue of Choice

THE DEEP SEATED ISSUE OF CHOICE
WHAT MAKES NEW IDEAS DIFFICULT?
citations are written without personal communication with involved residents or family members. Increasing the weight of the resident and family interview in the investigation, and in informal dispute resolution is an important part of refocusing the survey process. Some residents and family members may be uncomfortable with an increased role in this process; ombudsmen can strengthen their voice, or be their voice, if ombudsmen have adequate time in the facility to establish the relationships essential for appropriate advocacy. Appendix D offers a detailed set of recommendations for wording changes in the guidelines and investigative protocols to support resident choice and self-determination, and turns the focus on dining from a medical, technical, prescribed meal service to one offering quality of life in dining. (Recommendations for revision of the actual regulations are not included, due to the immediacy of the perceived need for reform.)
Recommendation: CMS support interdisciplinary survey team composition by reducing the nursing component and increasing representation of social service, therapeutic
recreation/activities, nutrition services and administration.
Recommendation: CMS review interpretive guidelines and investigative protocols to strengthen the outcome and resident satisfaction component and decrease the current focus
on process and documentation (see Appendix D).
Recommendation: All investigative protocols default to resident rights and self- determination, whenever applicable. All IDRs include resident and/or family involvement if there are issues of resident rights or choice, and ombudsman representation if family/resident are unable to participate or desire an ombudsman’s presence.
Survey Variability Can Be A Barrier
Rosalie Kane and Lois Cutler’s website, NH Regulations Plus, is a work in progress, comparing and cross-referencing nursing home rules from all 50 states. In Aging Today, they offer 10 maxims to inform the long-term care field attempting to bring about change. Their maxims:
1. When you’ve read one set of state regulations, you’ve read one set of state regulations.
2. State rules are more prescriptive than federal rules.
3. Almost all states have developed specific nursing staff-to-resident ratios. 4. Waivers drive innovation in new construction.
5. State regulations are moving toward greater disclosure requirements.
6. Paradoxically, regulation can sometimes promote resident freedom and
autonomy.
7. Reasons for state regulations are sometimes shrouded in mystery.
8. Some rules interfere with the ideal of the universal worker.
9. It ain’t necessarily so. Rules for nursing home, voluminous as they are,
cannot be blamed for all restrictions on residents.
10. When contradictions abound, a specific rule trumps a general one.
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