1 Rules of Participation, Phase 1 Review A Foundation check to launch Phase 2 from Presented by: Anabelle Locsin, RN, Ed.D., RAC-CT, LNC Quality Improvement Consultant
PROGRAM OVERVIEW 2 This program was developed to support the long term care professional navigate the turbulent waters of regulatory change found in the Rules of Participation (RoP) and support smooth sailing through November 28, 2017, phase 2 implementation by recapping key areas of phase 1. Participants will be guided through highlights of phase 1 in preparation for phase 2.
OBJECTIVES 3 Upon completion of his program, participants will be able to state the Two D's of RoP. 1. Discuss 12 Highlights of RoP Phase 1 (now foundational building blocks for Phase 2). 2. Describe educational needs to support transition.
Top 12 Phase 1 Highlights 4 A. Resident Rights B. Grievance C. Advanced Directives D. Freedom from Abuse, Neglect & Exploitation E. Admission, Transfer & Discharge Rights F. Resident Assessment G. Comprehensive person-centered care planning
Top 12 Highlights continued 5 H. Quality of Life I. Quality of Care J. Pharmacy K. QAPI L. Infection Control
Top 12 Highlights continued 6 A. 483.10 Resident Rights Uses language resident representative Roommate choices Right to Physician choice Clarifies right to access medical records
Top 12 Highlights continued 7 Resident Rights continued: Planning and implementing care Equal access to quality care Right to receive notices orally and in writing (including braille) in a format or language he/she can understand; how to contact an Aging & Disability Resource
Top 12 Highlights continued 8 B. 483.10 Grievance (F585) Inform how to file, who may be contacted to file Identify Grievance Official Grievance process
Top 12 Highlights continued 9 C. 483.10 Advanced Directives - Right to be informed (F552, F578, F678) Regarding his/her total health status, changes in the plan of care, care to be furnished & by whom In advance risks & benefits of proposed care, of treatment, & treatment alternatives/options Right to request, refuse,&/or discontinue treatment, to participate in or refuse to participate in experimental research & formulate an advance directive and Provision of Basic Life Support.
F 552 Planning and Implementing Care 10 New Issues: Right to be given information in advance of the care and the professional who is going to render that care Informed consent with information from physician or other practitioner or professional and right to choose alternatives
Total Health 11 Right to be informed of total health status including: Functional status Nutritional status Rehabilitation and restorative potential Ability to participate in activities Cognitive status Oral health status Psychosocial status Sensory and physical impairments In a way easy for resident to understand
F 578 Advance Directives 12 Subject to state law Must give information to resident, if incapable of understanding to resident representative, if regains ability to understand to resident Advance directives should be followed in accordance with state law If resident refuses treatment puts staff on notice that it should determine why and address the concern, if possible and put in care plan
F 678 CPR/Life Support 13 Staff must provide basic life support while awaiting EMT s Properly trained personnel 24/7 Must do unless valid DNRO governed by state law Needs policies and procedures Need policies and procedures to ensure resident s choices are preserved
Top 12 Highlights continued 14 D. 483.12 Abuse, Neglect, and Exploitation Resident has the right to be free from abuse, neglect, misappropriation mistreatment of resident property, and exploitation, includes but is not limited to freedom from corporal punishment, involuntary seclusion and any physical or chemical restraint not required to treat resident s medical symptom.
F 600 Freedom ANEMMI 15 483.12 (b) (5) Freedom from Abuse, Neglect, Exploitation, Misappropriation of Resident Property Mistreatment and Injury of Unknown Source. Includes corporal punishment, involuntary seclusion and restrains (physical and chemical Abuse includes deprivation of goods and services necessary to attain or maintain physical, mental and psychosocial well-being
16 In abuse, willful means deliberate not with intent to harm Sexual abuse is nonconsensual sexual contact of any kind Neglect mean the failure of the facility to provide goods and services necessary to avoid physical harm, pain, mental anguish or emotional distress Mental abuse can also include the use of technology
17 Facility must train staff considering the diversity of the facility population Facility cannot disown acts of staff Retaliation to a resident by staff is abuse no matter underlying reason Resident to resident actions can be abuse by the resident and abuse or neglect by staff Involves training and care planning
18 Visitor abuse can also be a problem of facility neglect if it has occurred before and not addressed Staff abuse of residents includes: Negative attitude toward residents Understaffing on a regular basis Lack of administrative oversight Staff burnout Inadequate training
19 Deficiencies in the physical environment Facility policies that do not favor the resident Behaviors that can provoke a negative reaction: Verbally aggressive behaviors Physically aggressive behaviors Sexually aggressive behaviors Touching another s property Wandering Resistance to care
20 Abuse may result in: Fear of a person, place or thing Extreme changes in behavior Running away, withdrawing, isolation, guilt, shame, depression, crying, talk of suicide These are red flags to caregivers Technical abuse is growing
F 602 MISAPPROPRIATION 21 Misappropriation includes: Identity theft Theft of money from bank accounts Unauthorized or coerced purchases on resident credit card Same with resident funds Resident giving gift to staff in exchange for good care Resident who provides monetary assistance to staff when staff member lets resident know of financial issues
22 Perceived as power over resident Puts resident in a vulnerable position for manipulation Staff cannot allow this to happen regardless Misappropriation is also taking resident medications for staff use or personal gain
F 603 Corporal Punishment 23 Interpretive Guidelines add discussion of corporal punishment and involuntary seclusion Must address behaviors before involuntary seclusion Must immediately consult with physician and resident designated representative Must provide necessary supervision to protect resident and other residents
24 Involuntary seclusion is: Disruptive behavior results in resident moved to separate location with trying interventions Confinement to an area with chairs or the like Staff holds door shut to prevent egress Staff place resident in secluded or darkened area for conveni4ence or punishment Remove resident s call light or other form of communication Resident put in secured unit without proper assessment and consent
F 606 BACKGROUND OF EMPLOYEES 25 Does not create federal background screening Adds abuse, neglect, exploitation, misappropriation of property or mistreatment to clarify what crimes are specific to preclude employment Note: Doesn t change state requirements
26 Adds that a person cannot be employed who has a disciplinary action in effect against his or her professional license related to abuse, neglect, exploitation, mistreatment and misappropriation Includes employees, medical director, consultants, contractors, and volunteers Caregivers who provide services on behalf of the facility (like hospice)
27 Also includes students Facility must make thorough investigation of histories of prospective staff
F 607 Written Policies & Procedures 28 Prevention including Screening Identification Investigation Training Protection Reporting
29 Screening: Employment history look for inconsistencies Information from previous employers Documentation of status and disciplinary actions from licensing and registration board even if not looking for job in the area where they are licensed or registered In Florida background screening
30 Training: Prohibiting and preventing anme Identifying what it is Recognizing signs of it Understanding behavorial symptoms of residents Aggressive or catastrophic behavior Resistance to care Outbursts or yelling Inability to adjust Reporting it
31 Prevention: Establishing a safe environment including consensual sexual activity Identifying, correcting and intervening in situations where ANME is likely to occur Determining that residents are getting resources Assessments Including as to visitors and others in building
32 Identification Include the obvious signs Suspicious injuries Sudden or unexplained changes in behavior
33 Investigation: Identifying staff responsible for investigation Protecting evidence Identifying and interviewing staff Focusing on determination of ANEMMI Documentation
34 Protection: Responding immediately Examining alleged victim Room or staffing changes, if appropriate Increased supervision of victim and other residents Protection from retaliation Providing emotional support and counseling as needed
35 In abuse, willful means deliberate not with intent to harm Sexual abuse is nonconsensual sexual contact of any kind Neglect mean the failure of the facility to provide goods and services necessary to avoid physical harm, pain, mental anguish or emotional distress Mental abuse can include the use of technology
F 553 Care Plan Process 36 Care plan person-centered Right to participate or have resident representative participate Right to identify persons and roles in care plan process Right to request meetings Right to request revisions to care plan
37 Right to participate in establishing goals and expected outcomes Right to be informed in advance of changes to care plan Right to receive services and items included in plan Right to see plan and sign off on significant changes Resident to be supported in this right
Items to Expect Surveyors to Check 38 Information directly from resident or representative by interview How staff interacts with resident in care planning process Whether care plans are scheduled to accommodate resident and/or their representative How staff answered residents questions and dealt with concerns
39 As to residents who are not able to participate in meeting, how did they get to interact By interview with staff, how do they inform residents of rights and incorporate preferences, choices and goals If the resident choice puts him at risk is there a process to examine the risk/benefit ration and guide decision-making
40 Look in record for assessment of resident s needs, strengths, whether personal and cultural preferences were incorporated in care plan process Determine how staff response to non-verbal communication (e.g. spitting out food) Determine if resident is given prompt access to care plan
Top 12 Highlights continued 41 H. 483.24 Quality of Life Provision of necessary care based on comprehensive assessment & consistent with resident s needs & choices Provision of basic life support during emergencies consistent with orders & advanced directives Activities of daily living care & services and Activities Program requirements
Top 12 Highlights continued 42 I. 483.25 Quality of Care All treatment and care provided to residents based on comprehensive assessment & in accordance with professional standards of practice Provide adequate supervision and assistance devices to prevent accidents Conduct regular inspection of all bed frames, mattresses, bedrails (identify entrapment risks)
Top 12 Highlights continued 43 J. 483.25 Pharmacy Services A psychotropic drug is any drug that affects brain activities associated with mental processes & behavior Pharmacy reports & irregularities, monthly drug regimen reviews, Unnecessary drugs Documentation of Physician, Medication errors
Top 12 Highlights continued 44 K. 483.75 Quality Assurance Performance Improvement Facility must maintain a quality assessment & assurance committee & membership requirements Committee reporting responsibilities & meetings Evaluate activities, identify issues, develop & implement plans of action, review & analyze data from drug regimen reviews, act, make improvements Disclosure of Information & Sanctions
Top 12 Highlights continued 45 L. 483.80 Infection Control 483.80 Except for (a) as linked to facility assessment 483.70 (e) Phase 2 Infection prevention and control program, annual review and updating as needed, education & training Written standards, policies, & procedures. Reporting diseases, Isolation requirements, work exclusions, hand hygiene procedures, Vaccination, Linens
Key Points 46 The different highlights discussed serves as a good starting point to build on the new changes as they serve as a good foundation to assure compliance with revised standards Make sure your policies and procedures are all in place and staff are continually re-educated on the changes to continue to re-inforce learning and application
Thank You! 47 To learn more contact us today! We appreciate your participation in this program. For more information please contact Dr. Anabelle Locsin at anabelle@rbhealthpartners.com or you may contact Robin A. Bleier for information and or services at robin@rbhealthpartners.com