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Transfer & Discharge Deficiencies; Link Between Nurse Hours and Antipsychotics; Webinar Next Week || Center for Medicare Advocacy

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  1. Report: Transfer and Discharge Deficiencies Cited Since 2017: Surveyors Focus On paperwork, Not Residents’ Rights
  2. Research Finds Link Between Registered Nurse Hours and Antipsychotic Drug Use
  3. Webinar: Expert Nursing Amenities Replace

Report: Transfer and Discharge Deficiencies Cited Since 2017: Surveyors Focus On paperwork, Not Residents’ Rights

The involuntary switch and discharge of nursing residence residents is the highest grievance acquired by nursing residence ombudsman packages nationwide.  In December 2017, the Facilities for Medicare & Medicaid Providers (CMS) introduced an initiative “to examine and mitigate facility-initiated discharges that violate federal regulations.”[1]  Whereas recognizing the seriousness of involuntary switch and discharge for residents (and calling a few of them “unsafe and/or traumatic for residents and their families”), CMS limits the initiative to reviewing solely switch and discharge deficiencies which might be cited following grievance investigations or annual surveys.  CMS’s Regional Workplaces usually are not reviewing both administrative selections by listening to officers in residents’ switch and discharge appeals or complaints made to the ombudsman program.

In August 2018, the Middle for Medicare Advocacy reviewed the switch and discharge deficiencies (F622) which were cited because the new uniform nursing residence survey course of went into impact in November 2017.  The Middle’s research finds that as of July 20, 2018, nationwide, 137 deficiencies for switch/discharge have been cited nationwide.  Solely 4 of those 137 deficiencies have been cited as both “harm” or “immediate jeopardy;” the remaining 133 deficiencies have been cited as “no-harm” or substantial compliance. 

The rationale for this coding is that the majority survey studies cited switch and discharge solely as a paperwork drawback.  Surveyors didn’t sometimes examine or doc what occurred after residents acquired notices that have been in violation of federal necessities.  Lacking or insufficient paperwork was cited as the only problem of noncompliance.  Surveyors usually didn’t comply with as much as decide whether or not residents have been truly discharged with out applicable discover or for inappropriate causes or with out preparation and, in that case, what occurred to them following discharge.  Within the few situations when surveyors investigated the circumstances of the discharge, they appeared to deal with the discharge much more critically.

For instance, the only quick jeopardy deficiency was cited at Brookhaven Manor, a Particular Focus Facility in Tennessee, following in an annual survey accomplished March 21, 2018.[2]  The deficiency was based mostly on the discharge of a resident to a lodge whereas his attraction of his discharge for alleged noncompliance with the power’s smoking coverage was pending earlier than a state Administrative Regulation Decide (ALJ).

On December 21, 2017, a resident was given a Discover of Involuntary Discharge for allegedly violating the power’s smoking coverage.  The resident filed an attraction.  In a February 2, 2018 convention name, the state ALJ listening to his attraction issued a continuance of the attraction till February 21 in order that the resident might get an lawyer.  When the resident was discovered smoking on Friday, February 9, the interim administrator (who had begun working on the facility on January 29) requested the resident for his matches or lighter.  When the resident refused, he was instantly discharged to a lodge, pushed within the facility’s van.  The power paid for three nights on the lodge, which served breakfast, however facility employees didn’t know if the person had any cash to pay for further meals.  The power additionally did not ship all the resident’s prescribed drugs with him to the lodge.  The previous resident advised surveyors he had one meal on Friday and, as described within the survey report, “2 boxes of peanut butter crackers and some candy to eat for the following 3 days.”  Neither the resident’s doctor nor the power’s Medical Director had been consulted previous to the resident’s discharge.

The state company cited a complete of six instant jeopardy deficiencies associated to the involuntary discharge, together with, along with F622, deficiencies at F623 (failure to offer well timed notification of discharge), F624 (failure to organize resident for protected discharge), F745 (failure to offer medically-related social providers), F835 (administration), F837 (governing physique), and F867 (high quality assurance and efficiency enchancment).  Nursing Residence Examine doesn’t report any Civil Cash Penalties for these deficiencies and it’s unknown whether or not any penalty for these deficiencies has been imposed and is underneath attraction. 


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Research Finds Link Between Registered Nurse Hours and Antipsychotic Drug Use

Human Rights Watch (HRW) revealed a devastating report in February 2018, which discovered that over 179,00zero nursing residence residents have been being administered off-label antipsychotic medicine each week.[1] Antipsychotic medicine are indicated to deal with particular medical circumstances, akin to schizophrenia, and not the behavioral signs of dementia. However, the HRW report famous that a lot of the residents on antipsychotic medicine have Alzheimer’s illness or different types of dementia.[2] In response to the Meals and Drug Administration’s “black box” warning, using antipsychotic medicine on aged sufferers is related to a considerably elevated danger of demise.[3]

As many studies have indicated, together with these written by the Middle for Medicare Advocacy,[4] one issue within the inappropriate use of antipsychotic medicine in nursing houses has been insufficient nurse staffing. A recently-published research within the Journal of Psychiatric and Psychological Well being Nursing (JPMHN), entitled “An observational study of antipsychotic medication use among long-stay nursing home residents without qualifying diagnoses,” has discovered additional correlation between registered nurse hours and antipsychotic drug use.

The authors of the Research discovered that “[o]ne additional registered nurse hour per resident per day could reduce the odds of antipsychotic use by 52% and 56% for residents with and without a dementia diagnosis respectively.”[5] Taking a look at nursing amenities within the state of Missouri, the authors discovered that simply assembly the nationwide common for registered nurse hours (.eight hours) would end in a 22% discount within the odds of inappropriate antipsychotic drug use in residents with dementia; the discount will increase to 25% for residents with out dementia.[6]

The federal Nursing Residence Reform Regulation states that each nursing residence resident is entitled to providers that attain or keep his or her “highest practicable physical, mental, and psychosocial well-being.” Because the JPMHN Research exhibits, adequate registered nurse hours are important to enhancing residents’ high quality of care and high quality of life and assembly the necessities of federal regulation.

NOTE: Nursing house residents have rights and protections underneath federal regulation. Nursing houses should not administer an antipsychotic drug until it’s medically essential to “treat a specific condition as diagnosed and documented in the clinical record.”[7] When residents are already on antipsychotic medicine, nursing houses should undertake gradual dose reductions and behavioral interventions, until clinically contraindicated, to discontinue the drug.”[8]


[1] See Hannah Flamm et al., “They Want Docile”: How Nursing Houses in the USA Overmedicate Individuals with Dementia, Human Rights Watch (Feb. 2018), https://www.hrw.org/report/2018/02/05/they-want-docile/how-nursing-homes-united-states-overmedicate-people-dementia (noting that “[t]he drugs are often given without free and informed consent . . . .”).
[2] Id.
[3] Atypical Antipsychotic Drugs: Use in Adults, CMS, https://www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/Medicaid-Integrity-Education/Pharmacy-Education-Materials/Downloads/atyp-antipsych-adult-factsheet11-14.pdf (final visited 9/19/2018) (“Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death.”).
[4] See e.g., Toby Edelman, Elder Abuse in Nursing Amenities: The Over-Administration of Antipsychotic Medicine to Nursing House Residents, Middle for Medicare Advocacy (Jun. 15, 2016), http://www.medicareadvocacy.org/elder-abuse-in-nursing-facilities-the-over-administration-of-antipsychotic-drugs-to-nursing-home-residents/ (“There is a solution to this form of elder abuse! Improve staffing levels in nursing facilities. Long-standing evidence confirms that nursing facilities employ too few nurses to meet residents’ needs.”). 
[5] Lorraine J. Phillips et al., An observational research of antipsychotic treatment use amongst long-stay nursing residence residents with out qualifying diagnoses, Journal of Psychiatric and Psychological Well being Nursing (Jun. 17, 2018), https://onlinelibrary.wiley.com/doi/10.1111/jpm.12488 (taking a look at 2015 long-stay residents in Missouri who lacked a qualifying or probably qualifying analysis for antipsychotic medicine).
[6] Id.
[7] 42 C.F.R. § 483.45(e)(1).
[8] 42 C.F.R. § 483.45(e)(2).

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Webinar: Expert Nursing Amenities Replace

Wed, Sep 26, 2018 three:00 PM – four:00 PM EDT

The webinar will present an summary of Nursing Residence High quality of Care & High quality of Life Requirements from a shopper perspective.

Presenters: Middle for Medicare Advocacy Senior Coverage Lawyer Toby Edelman and Coverage Lawyer Dara Valanejad, with particular visitor lawyer Richard J. Mollot, Government Director of the Lengthy Time period Care Group Coalition.

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