Joan Devine, RN-C
Director of Education, Pioneer Network
The new CMS conditions of participation go into effect on November 27, 2017 – a little more than a month away. No doubt there is apprehension and even a little panic among providers as they prepare their teams to meet these revised standards.
But wait – slow down, take a deep breath and take a look at what you are already doing. For those of you who have embraced the ideals and practices of person-centered care, you’ve been preparing for this day for years!
Let’s start by looking at what is NOT NEW in the revised standards. In OBRA ’87, we were told that “each resident must receive & facility must provide necessary care & services to attain or maintain the highest practicable physical, mental & psychosocial well-being.” Sounds pretty much like a foundational statement for person-centered care – doing the right thing for each individual resident to assure that they are provided with the care and services that support them in being the best that they can be! And the regulations, three of the words seen over and over again are dignity, respect and choice. Looking at the Pioneer Network values and principles, it is evident that these three things are embedded into our beliefs. So, if you have been practicing according to these standards, your foundation is solid.
Moving on to the new Conditions of Participation (COP), CMS defines person-centered care in this way: “To focus on the resident as the locus of control and support the resident in making their own choices and having control of their daily lives.” And so, in addition to dignity, respect and choice, there are two other words that we now see on almost every page of the new COP – “preference” and “individualized”. So, if I can paraphrase, it would seem that what CMS is expecting us to do is provide care and services to the residents in a way that is dignified, respectful, supports choice, and is based on knowing and honoring their individual preferences.
But wait a minute – when we create a culture based on the values of person centeredness, we are doing that…so is that it? Is that all we have to do? Well, not entirely.
Passion alone is not the answer to compliance. Having the process behind your passion is what is needed to support quality of life for residents and to assure that you are doing the right thing. And what about quality of care? Remember that by setting the target at quality of life, you will attain quality of care, as meeting care needs is foundational to assuring quality of life. (For more on this, check out the July 2016 Pioneer Network blog, Culture Change or Person-Centered Care, What is the Real Journey?)
So, let’s get down to specifics. Money and resources are tight, with time being one of the most valuable of our resources, so what can you do to help assure that the processes behind your passion are sound?
Pioneer Network Resource Library includes a wealth of tools to help you out – and so many of them are free!
One way to start is by assessing where you are – allowing you to celebrate the things you are already doing and then building on your strengths as you move forward. A few tools to help you with this are the Artifacts of Culture Change and the Quick Organizational Self-Assessment.
Under the Getting Started Toolkits, you will find the free, online starter toolkit for “Engaging Staff in Individualized Care”. A powerful tool to use in training your staff in the use of the four fundamental practices of consistent staffing, huddles, involving CNAs in Care Planning and QI close to the resident.
If dining practices have you challenged, then check out the Just in Time Toolkit for Dining as well as a variety of other helpful tools in the dining section of the Resource Library.
And of course, creating Person-Centered Care Plans required in the new COP are something we believe in, yet struggle with how to accomplish. How do you get the required staff involved in the process? What if resident preferences pose a risk? The engaging staff toolkit noted above can help you with developing the processes to support staff engagement and communication. As for addressing risk, A Process for Care Planning for Resident Choice, developed by the Rothschild Person-Centered Care Planning Task Force, is an excellent tool to use. (It’s even referenced by CMS in the new COP.) And to pull it all together, the 4 webinars from this year’s At the Table webinar series on care planning are available for purchase through the webstore, individually or as a series.
In a recent dialogue between members of the staff at CMS and Pioneer Network, ideas were shared on how to help providers as they work to implement person-centered practices and meet the new requirements. One way identified is to make sure that your organization defines the processes that support the implementation of person-centered practices and understands that being person-centered doesn’t mean throwing all caution to the wind; in fact, just the opposite. It is looking at all the needs of the individual(s) along with their goals and preferences. It’s being sure you have defined in process, policy and procedure – the who, where, why and how supporting what you do.
And secondly, communication is key! We are all trying to figure out what all this means and how it will work. For the providers, how to apply the guidance and for the surveyors, how to determine if the guidelines are being met. Don’t be afraid to have that conversation with your surveyors as you are developing your tools and processes for meeting the new standards.
If you hear something that you are not sure if it is true or it just doesn’t make sense, ask! Questions can be submitted directly to CMS at NHSurveyDevelopment@cms.hhs.gov. or feel free to send them to the team at Pioneer Network at info.pioneernetwork.net and we will help you find the answers.
Myths can be debunked! In our recent call with CMS staff, that’s just what happened when we shared what we were hearing from providers – that they could no longer have pot lucks or accept corn from the local farmers to serve to their residents. Not true! Our advice – if this is something that you have been doing or have wanted to do because it is meaningful to your residents and helps connect them to the greater community, don’t abandon it. Instead, assess the processes and systems that support what you want to do and consider talking with your local surveyors about what you are doing – be proactive! It’s not a no, it’s a do it right!
No, it isn’t easy. We are all learning and interpretation is just that…interpretation! Even among those who believe passionately in this movement, there is disagreement. We can’t even all agree on whether the terminology should be Person-Centered Care or Living, Person-Directed Care or Living, Relationship-Centered Care, etc.! What we do all agree on is that we are here to support a better life for the residents we serve. As providers, we are learning and so are the surveyors, residents, families and all the organizations that support providers, residents and families.
Remember, as you address resident choice and preferences, as you look to incorporating person-centered care practices into your organization’s culture, it’s not a no, it’s a do it right!