What would you tell people who feel anxious about meeting the new regs?

November 16, 2017
Carmen Bowman

Regulatory expert/guest blogger, Carmen Bowman, has an answer:

First of all, to answer this question, the “new” regs actually contain most of the “old” regs, so there is that. Much of these requirements should not be a surprise to any of us and hopefully compliance with the older regs has been in place for a long time.

Next, we see many culture change practices now having risen to the level of regulation. That should excite us, not make us nervous … hopefully. Person-centered, resident choice, preferences and resident goals are now quite prevalent in the regulations. Wait until you see the number count. The increase in numbers is a big change.

The new regulations actually define person-centered care now, stating it as a “means to focus on the resident as the locus of control and support the resident in making their own choices and having control over their daily lives.”  That should sound super familiar. It is thanks to The Eden Alternative, Pioneer Network and many other change agents in our 20-year culture change movement that have caused this to come about! And those dedicated to the principles of The Eden Alternative and culture change would already have this ingrained in their organizational culture, I would think. In fact, CMS has stated, “many of the quality of life improvements changes in this final rule are grounded in the concepts of person-centered care and culture change.”

New requirements that align with a changed culture seeking to bring decision-making closer to the Elder, include to protect and promote the rights of the resident. We are not just to tell residents what their rights are, we need to step it up and actually protect and promote them. Resident’s wishes and preferences must be considered in the exercise of rights by the representative. This reveals what even CMS knows, that many resident representatives have not been honoring what the individual wants.

We are to ensure that residents are “informed of risks and benefits of proposed care, of treatment alternatives or treatment options and to choose the alternative or option he or she prefers.” I distinctly remember Dr. Bill Thomas at the first-ever Surplus Safety Symposium in 2012 say, “If you had cancer, God forbid, I as a physician would give you your options and you would decide!” And there it is… finally in the regulations.  And there’s more: individualized approaches, meaningful engagement and meaning and purpose are also in the regs. Even the Eden Alternative Domains of Well-being made the cut! Yes, its true.

Again, thought leaders like Dr. Thomas have reminded us that it’s about LIFE for the resident, not just care. Care gets too much attention.

I would guess that if a team is nervous, it might mean that you know you are not yet offering the practices that reflect a non-institutionalized culture, like you want to. So, since many are now required, let the urgency of compliance prompt you to do what you’ve been wanting to do all along.  And, remember, don’t just strive to meet the regulations, strive to meet the desires of how the people, who live where you only happen to work, want to live LIFE on their terms.

In my opinion, culture change – changing institutional culture to one of home, vibrant life, all-about-the residents – is the answer to everything, all the time. The answer to meeting new regs, the answer to staff shortages, the answer to retention, the answer to giving good care and the answer to supporting residents to LIVE a good life each day.

We will dig into this much, much more in the upcoming Eden Alternative Feature Webinar Series, Ready, Set, Go: Person-Directed Care & the New Regulations.  Join myself and Vickie Burlew for one or both of the webinar events in this series to really connect the dots and get ahead of the curve.

1 Comment. Leave new

i am an ombudsman and several residents told me with great upset that the small kitchen area on each floor that houses the microwave, refrigerator, ice machine and water dispenser now has a door with a keypad to keep residents out. they complain that they sometimes have to wait a half hour or so to get more ice or water. when a couple of them went to see the administrator he reportedly told them that this is mandated. he was not available for me to talk with, and i want to understand any issues involved here re supposed compliance so i’m prepared when i meet with him.
so much for life as residents want…

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