Updated Guidance for Nursing Home Resident Health and Safety

Topic

Summary

Abuse and Neglect

• Clarifies compliance, abuse reporting, including sample reporting templates, and provides examples of abuse that, because of the action itself, would be assigned to certain severity levels.

Admission, Transfer, and Discharge:

• Clarifies requirements related to facility-initiated discharges.

Mental Health/Substance Use Disorder (SUD):

• Addresses rights and behavioral health services for individuals with mental health needs and SUDs.

Nurse Staffing (Payroll-Based Journal):

• Uses payroll-based staffing data to trigger deeper investigations of sufficient staffing and added examples of noncompliance.

Resident Rights:

• Imports guidance related to visitation from memos issued related to COVID-19, and makes changes for additional clarity and technical corrections.

Potential Inaccurate Diagnosis and/or Assessment

• Addresses situations where practitioners or facilities may have inaccurately diagnosed/coded a resident with schizophrenia in the resident assessment instrument.

Pharmacy:

• Addresses unnecessary use of non-psychotropic drugs in addition to antipsychotics, and gradual dose reduction.

Infection Control:

• Requires facilities have a part-time Infection Preventionist.
• While the requirement is to have at least a part-time IP, the IP must meet the needs of the facility.
• The IP must physically work onsite and cannot be an off-site consultant or work at a separate location.
• IP role is critical to mitigating infectious diseases through an effective infection prevention and control program.
• IP specialized Training is required and available.

Arbitration:

• Clarifies existing requirements for compliance when arbitration agreements are used by nursing homes to settle disputes.

Psychosocial Outcome Severity Guide

• Clarifies the application of the “reasonable person concept” and severity levels for deficiencies.

State Operations Manual Chapter 5

• Clarifies timeliness of state investigations, and communication to complainants to improve consistency across states.