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CMS and Culture Change

CMS is Committed to Culture Change. It's in the Administrator's Action PlanNot only for the past year but ongoing line itemWe've ?institutionalized" culture change ? it's part of CMS now. What's Been Happening. Sent to all survey agencies and CMS ROs two Culture Change for Regulators audio trainin

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CMS and Culture Change

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    1. CMS and Culture Change Karen Schoeneman Acting Deputy Director CMS Division of Nursing Homes

    2. CMS is Committed to Culture Change It’s in the Administrator’s Action Plan Not only for the past year but ongoing line item We’ve “institutionalized” culture change – it’s part of CMS now

    3. What’s Been Happening Sent to all survey agencies and CMS ROs two Culture Change for Regulators audio trainings Phila. RO co-sponsored culture change conf. In Delaware – all RO and State surveyors came Presentation in Virginia – their State surveyors came ROs speaking at CC events when invited

    5. The Environment Symposium Was CMS idea, they asked Pioneers to co-sponsor Nearly 40 regulators there to listen while innovators presented on environment changes and reg. Issues Public comment periods

    6. Symposium Details CMS contracted with your own Carmen Bowman for Background paper Moderate symposium and post-sym workshop Post-conference transcript

    7. What It Covered Private rooms – business case Home and homelike Life safety code – who are they and how do you change it State success stories Day 2 recommendations workshop for speakers, regulators, stakeholders, culture change experts

    8. The Recommendations Four categories For CMS For State survey agencies and State coalitions For researchers For the Life Safety Code

    9. So What is CMS Doing with Their Recommendations Drafted revisions to several quality of life and environment tags per symposium recommendations Now revised draft further per stakeholder group and regulator comments Moving through CMS clearance for issuance – that means our lawyers have to say ok

    10. Tag Revisions F172 Visitation – expanded 24 hour visiting access to all visitors, adds language about security, restricting abusers F175 Married Couples – this reg. Gives right to share room – language added that the reg. doesn’t prohibit residents to share room with any person of their choice

    11. Tag Revisions F241 Dignity – clarified what signs can be posted where, also covers staff not verbally talking confidential info. where residents and public can hear; residents not to be restricted from common areas including lobby, restrooms – leeway for certain residents, and for certain restrooms that do not have call cord

    12. Tag Revisions F242 “Choices” – Clarifies choice over schedules F246 Accommodation of Needs – Adds information about needed adaptations to bedrooms and bathrooms such as drawer handles, bath mirror, furniture arranging, toiletries in reach, staff communication at eye level, etc.

    13. Tag Revisions F247 Notice Before Room or Roommate Change – If roommate passed away and resident is grieving, try to give a little time before new roommate, if resident is being moved: take resident to see new room, discuss issues

    14. Tag Revisions F252 Safe, Clean, Comfortable Homelike Environment – Refers issues of safe, clean to other tags; defines intent of “homelike” – as close to private home as feasible, strive for elimination of institutional practices

    15. Tag Revisions F256 Lighting – Defines features of adequate lighting design (with leeway for older homes) Minimum of glare – elim. shiny floors, even lighting in hallways, window coverings, task lighting, night-time way-finding, dimming or flashlights for night, color contrast bathroom wall or toilet seat, contrast between dishware, table, and food

    16. Tag Revisions F461 (Closet portion) –Clarify residents need to be able to reach their clothing in closet F463 Call System – Gives allowance for wireless systems that ring to caregivers

    17. Other CMS Post-Symposium Activities Did webinar for QIOs with Carmen B. and PN Pre-con at PN conference 8/08 Full-day pre-con 10/08 at AAHSA, invited by Larry Minnix Participating in new PN small house grant project

    18. Some State Reg Activities Arkansas was presenter at symposium, already had State regs. out for revision and comment. Adding special section for Green House type settings and giving out grants for GHs Kansas and Florida are drafting changes too

    19. I’ve been talking to State regulators Here’s what Virginia says: They added text in 1997 that allows a home proposing “unique design solutions” to apply to get them approved by the survey agency. This gives leeway for innovations not conceived today, so regs. aren’t a barrier

    20. Likely will participate in LSC committee CMS is allocating small pot of contract funds for next two years for CC projects, as yet undefined ANY GOOD IDEAS? The Future?

    21. Quick Fixes for the Environment Symposium highlighted many things each home can do to enhance accommodation of environment to resident needs. Let’s look at some - - - -

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