CMS Proposes First Nursing Home Reform Rules in Quarter Century

Federal guidelines for nursing homes appear to be on the verge of getting their first overhaul in almost a quarter of a century, which would help ensure employees at long-term care facilities have proper skills in addressing behavioral issues, mental illness and nutritional needs of residents. 

On July 16, the U.S. Centers for Medicare & Medicaid Services (CMS) published a proposed rule (PDF) on reforming requirements for long-term care facilities in the federal register, opening the guidelines for public comment.

The proposal was also highlighted by President Barack Obama at the recent White House National Conference on Aging last week. The rule is one of a list of suggestions aimed at improving the lives of the elderly in the U.S.

“[W]e’re going to make it easier for folks who are homebound to get nutritional assistance, We’re going to update the quality and safety requirements for thousands of nursing homes — the first major overhaul in nearly 25 years,” President Obama said in the conference’s opening remarks. “We’re going to train more prosecutors in how to combat elder abuse.”

The new rules for nursing homes will require staff to be trained on how to address behavioral issues among residents and how to respond properly and care for residents with mental illness. It is hoped these measures would cut down on the use of certain antipsychotics as a form of chemical restraint, as well as prevent some cases of nursing home abuse.

The proposed rules would also require training on proper nutrition, and require facilities to have food available that takes into account resident allergies, preferences and intolerances. It is hoped that these measures would reduce cases of nursing home malnutrition and dehydration.

Another major part of the reform rules would involve the creation of a new compliance and ethics program. According to the rules, every nursing home and long-term care facility would have to have policies and procedures in place, in writing, to prevent ethical and criminal violations.

The new rules are expected to cost facilities an average of about $40,000 per year.

The proposal would also address pain management, dialysis requirements and other medication and treatment needs, and bans the use of any physical or chemical restraints that are not specifically prescribed to treat medical symptoms as part of a package of reforms titled “Freedom from Abuse, Neglect, and Exploitation.”

The FDA has previously warned against the use of antipsychotics with dementia patients, indicating that the medications provide no benefits and may increase the risk of death. Given what is known about the potential side effects of antipsychotics, use of the medications is often considered a form of elderly abuse when the purpose is to sedate the individual, rather than treat.

The Department of Health and Human Services (HHS), in conjunction with other federal agencies and private groups, is already battling antipsychotic drug use in nursing homes through the National Partnership to Improve Dementia Care and other efforts.

In September 2014, the National Partnership to Improve Dementia Care announced that it has set a goal of reducing the use of antipsychotics in long-term care facilities by 25% before the end of 2015. The group hopes to see reductions of 30% by the end of 2016.

The public has 60 days to comment on the proposed rules. See the Federal Register notice for information on how to submit public comments.