CMS Nursing Home Regulations

Nursing homes, also known as long-term care facilities, are growing in number and need, as the baby boomer generation becomes a force to be reckoned with. Baby boomers, those individuals born between 1946 and 1964, are considered to be the largest group of Americans that will be reaching the age of 65 by the year 2010. Caring for seniors provides a constant challenge to nursing care facilities, for which the CMS (Centers for Medicare and Medicaid Services) are addressing. Nursing home regulations and standards change and improve every year; understanding some of them will help individuals choose the best locations for long-term care.

Definition of CMS

• The Centers for Medicare and Medicaid is a government organization that oversees various aspects of health care, including senior health care in a variety of facilities, including but not limited to hospitals, long-term care facilities, nursing homes, psychiatric hospitals and facilities, Hospice care and Home Health Care providers. To be reimbursed for payment for services rendered, facilities must be inspected and certified by CMS guidelines in coordination with inspection criteria from the CMS and the American Health Care Association.

Function

• The function of CMS regulations and guidelines is to provide quality of care in all areas of patient care scenarios in a multitude of facilities. From inpatient rehab to critical access hospitals, CMS focuses attention on safety, quality of care, skilled nursing care and adherence to federal and state regulations and standards of care provided by health care facilities around the country. Annual inspections determine compliance with current rules and regulations as determined by CMS and the AHCA before certification is granted or maintained.

Survey Focus

• Annual surveys performed by state inspectors determine compliance to rules and regulations of care provided in long-term care facilities. Some of the quality measures for long-stay residents include but are not limited to standards of care in use of restraints, presence of infections such as UTIs (urinary tract infections), pain management, percentage of pressure ulcers (bedsores), weight loss and more. Inspectors also assess nursing services, dental services, infection control, physical environment, resident rights and quality of life issues for every facility they inspect.

Quality of Life Issues

• One of the most important aspects of CMS guidelines in relation to nursing homes is patient's rights and quality of life issues. Inspectors examine every patient's ability and freedom to participate in family or resident group activities as well as making sure needs are accommodated. Clean environments and the ability of residents to exercise free choice, as well as be ensured of privacy and confidentiality, are also researched. Quality of care also ensures that patient's are given adequate aid to perform daily living activities and are protected from accidents, falls and other issues that may affect quality of life.

Nursing Services

• CMS guidelines and regulations are strict in regard to expectations of skilled nursing care for long-term facility and nursing home residents. Sufficient staffing, registered nurses and dietary services are to be provided, as are physician services and visits. Patients are to be given the proper medications and correct dosages of medications, while facilities are to prevent infections and provide a safe environment for residents.

Long Term Care Survey

• Every year, the AHCA (American Health Care Association) publishes a survey that state inspectors utilize to ensure that standards of care are upheld and complied with on a yearly basis. The survey offers nearly 500 pages of specific factors that CMS and AHCA looks for in regarding to providing quality performance and care for nursing homes and long term care facilities.