Navigating The New Rule: Person-Centered Care
This month’s column builds on the December Quality Forum about the new Centers for Medicare & Medicaid Services (CMS) Rules for Participation in Medicare and Medicaid, which is currently in the first of three phases of implementation.
Having spent much of my career translating regulations into Quality Assurance and Performance Improvement processes, my goal in this “Navigating the New Rule” series will be to highlight actions that you can begin today to improve quality and prepare for the evolving regulatory process.
Person-centered care was highlighted by CMS in its 2016 Quality Strategy for all beneficiaries they serve in all settings as “Goal 2: Strengthen persons and their families as partners in their care.” The result of that goal would be that, “Persons and families are engaged as informed, empowered partners in care.”
Applying this philosophy or approach to care in nursing centers requires a proactive approach to eliciting resident and/or family concerns at every stage of care. The new rule is clear that person-centered care is applicable to new admissions who expect to be discharged after a short post-acute care stay and long-term residents, including those with dementia who may not be able to clearly articulate their wishes.
All of this begins with the comprehensive person-centered care plan, which is included in the phase one regulation (483.21). The regulation now includes an explicit expectation that the resident and/or the resident’s personal representative will be interviewed during the development of the care plan.
The regulation then goes on to require that the resident’s choices as well as cultural preferences are represented in the care plan.
‘Identifying the resident’s discharge goals, needs, and resources is now explicit.’
While honoring resident preferences in daily routines, food, and activity has always been present in the regulations, with explicit questions related to these in the Quality Indicator Survey process, the new regulations take it a step further. It is not enough to document preferences and accommodate them through standardized care to the extent possible. Rather, the care plan is now expected to include strategies to support the resident in receiving care that they require.
This includes an emphasis on understanding and addressing cultural diversity and accommodating differences in preferences. This may take time, resources, and finding a balance between each person’s expectations with what is possible in your center.
For new admissions, the comprehensive person-centered care plan now has substantial requirements related to discharge planning. Identifying the resident’s discharge goals, needs, and resources is now explicit.
A fundamental principle in person centered care is communication with the resident and/or personal representative about what is contained in the care plan. Without timely information about plans of care while in your center and for the period after discharge, the resident and representative are not empowered to raise alternatives that they prefer. This is the most significant cultural shift for any health care organization: Care planning becomes a negotiation.
Finally, there is considerable reference in the new regulation to assessing and updating the care plan as needed. Both short- and long-stay residents and their families have the right to change their preferences as their health and outlook change. Being attuned to such changes requires ongoing updates to the plan of care.