Long Term Care

The new guidance also calls on nursing homes to de-institutionalize their physical environments. The guidance highlights institutional practices that facilities should strive to eliminate, including meals served on institutional trays and noise from overhead paging systems, alarms and large nursing stations.

A homelike environment is not achieved simply through enhancements to the physical environment, according to the new guidance. It concerns striving for person-centered care that emphasizes individualization, relationships and a psychological environment that welcomes each resident and offers comfort.

The guidance also makes clear that residents have the right to choices concerning their schedules — consistent with their interests, assessments and plans of care. Choice over schedules includes, but is not limited to, those matters that are important to the resident, such as daily waking, eating, bathing and going to bed at night. The facility should gather this information in order to be proactive in assisting residents to fulfill their choices.

The new guidance provides a substantial roadmap for environmental and culture change in nursing homes, while noting that some facilities are further along than others. As noted in the guidance: “many facilities cannot immediately make these types of changes, but it should be a goal for all facilities that have not yet made these types of changes to work toward them.”

Click here to view the new nursing home guidance.

Source: Centers for Medicare & Medicaid Services, June 19, 2009

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