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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.

+ ThankYouForJoiningUsToday!Emailinfo@ltccc.org 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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