implementation of minimum standards for dementia special...
TRANSCRIPT
![Page 1: Implementation of Minimum Standards for Dementia Special ...blog.mass.gov/publichealth/wp-content/uploads/sites/11/2013/08/PHC... · Implementation of Minimum Standards for Dementia](https://reader031.vdocument.in/reader031/viewer/2022030412/5a9e0bef7f8b9a4a238df5e6/html5/thumbnails/1.jpg)
Slide 1
Informational Briefing on Proposed Amendments to 105 CMR 150.000 for the Implementation of Minimum Standards for Dementia Special Care Units and
Serious Incident and Accident Reporting and Disaster Plans
Madeleine Biondolillo, MDDirector, Bureau of Health Care Safety and Quality
August 14, 2013
![Page 2: Implementation of Minimum Standards for Dementia Special ...blog.mass.gov/publichealth/wp-content/uploads/sites/11/2013/08/PHC... · Implementation of Minimum Standards for Dementia](https://reader031.vdocument.in/reader031/viewer/2022030412/5a9e0bef7f8b9a4a238df5e6/html5/thumbnails/2.jpg)
Slide 2
Agenda
A. Dementia Special Care Units•
Background on statute
•
Description of Proposed Amendments to 105 CMR 150.000
•
Next Steps and Questions
B. Serious Incident Reporting and Disaster Plans•
Description of Proposed Amendments to 105 CMR 150.000
•
Next Steps and Questions
![Page 3: Implementation of Minimum Standards for Dementia Special ...blog.mass.gov/publichealth/wp-content/uploads/sites/11/2013/08/PHC... · Implementation of Minimum Standards for Dementia](https://reader031.vdocument.in/reader031/viewer/2022030412/5a9e0bef7f8b9a4a238df5e6/html5/thumbnails/3.jpg)
Slide 3
Dementia Special Care Units
![Page 4: Implementation of Minimum Standards for Dementia Special ...blog.mass.gov/publichealth/wp-content/uploads/sites/11/2013/08/PHC... · Implementation of Minimum Standards for Dementia](https://reader031.vdocument.in/reader031/viewer/2022030412/5a9e0bef7f8b9a4a238df5e6/html5/thumbnails/4.jpg)
Slide 4
Background
![Page 5: Implementation of Minimum Standards for Dementia Special ...blog.mass.gov/publichealth/wp-content/uploads/sites/11/2013/08/PHC... · Implementation of Minimum Standards for Dementia](https://reader031.vdocument.in/reader031/viewer/2022030412/5a9e0bef7f8b9a4a238df5e6/html5/thumbnails/5.jpg)
Slide 5
Background
•
Chapter 142 of the Acts of 2012 requires the Department to
promulgate regulations to establish minimum standards for
Dementia Special Care Units (DSCUs)
–
Dementia‐specific training for all direct care workers, activities directors
and supervisors of direct care workers in both traditional nursing homes
and DSCUs;
–
Activities programs in DSCUs; and
–
Guidelines for DSCU physical design
•
Statute includes a Disclosure provision that promotes
transparency and consumer decision‐making
![Page 6: Implementation of Minimum Standards for Dementia Special ...blog.mass.gov/publichealth/wp-content/uploads/sites/11/2013/08/PHC... · Implementation of Minimum Standards for Dementia](https://reader031.vdocument.in/reader031/viewer/2022030412/5a9e0bef7f8b9a4a238df5e6/html5/thumbnails/6.jpg)
Slide 6
Background
•
Approximately 60% of all nursing home residents have some
form of dementia
•
Research suggests that staff members caring for dementia
residents need to understand –
The disease process and overview of dementia
–
Communication with residents with dementia
–
Mitigating safety risks while promoting freedom of movement
–
Managing behavioral challenges
•
Therapeutic recreation is the backbone of specialized
dementia care.–
Activities in a DSCU are the most important non‐pharmacologic
intervention for residents
![Page 7: Implementation of Minimum Standards for Dementia Special ...blog.mass.gov/publichealth/wp-content/uploads/sites/11/2013/08/PHC... · Implementation of Minimum Standards for Dementia](https://reader031.vdocument.in/reader031/viewer/2022030412/5a9e0bef7f8b9a4a238df5e6/html5/thumbnails/7.jpg)
Slide 7
Background
•
DPH reviewed regulations from 16 other states that have minimum
standards for
DSCUs in nursing homes
•
Training:–
Initial Training requirements range from 4 to 40 hours; median is 8 hours–
Ongoing Training requirements range from 2 to 12 hours; most common is 4 or 8
•
Activities:–
Six states require scheduled activities to be provided 7 days per week–
One state requires 8 hours per day, 7 days per week
•
Physical Design:–
Maintaining the DSCU physically separate from traditional units–
Egress control–
Secured outdoor space–
Common area that measures between 20 – 27 square feet for each bed on the unit–
Lighting and finishing standards to diminish confusion and agitation–
Safety Standards
![Page 8: Implementation of Minimum Standards for Dementia Special ...blog.mass.gov/publichealth/wp-content/uploads/sites/11/2013/08/PHC... · Implementation of Minimum Standards for Dementia](https://reader031.vdocument.in/reader031/viewer/2022030412/5a9e0bef7f8b9a4a238df5e6/html5/thumbnails/8.jpg)
Slide 8
Background
•
DPH has been working closely with the following stakeholders to craft minimum standards that will
best promote patient safety and high‐quality care:
–
Alzheimer’s Association
–
Executive Office of Elder Affairs
–
LeadingAge
–
Mass Advocates for Nursing Home Reform
–
Mass Senior Care
![Page 9: Implementation of Minimum Standards for Dementia Special ...blog.mass.gov/publichealth/wp-content/uploads/sites/11/2013/08/PHC... · Implementation of Minimum Standards for Dementia](https://reader031.vdocument.in/reader031/viewer/2022030412/5a9e0bef7f8b9a4a238df5e6/html5/thumbnails/9.jpg)
Slide 9
Proposed Amendments
![Page 10: Implementation of Minimum Standards for Dementia Special ...blog.mass.gov/publichealth/wp-content/uploads/sites/11/2013/08/PHC... · Implementation of Minimum Standards for Dementia](https://reader031.vdocument.in/reader031/viewer/2022030412/5a9e0bef7f8b9a4a238df5e6/html5/thumbnails/10.jpg)
Slide 10
Definitions
Dementia Special Care Unit (DSCU)
means a nursing home, or a
unit thereof, that uses any word, term, phrase, or image, or
suggests in any way, that it is capable of providing specialized
care for residents with dementia, and which must comply
with 150.022 through 150.029. The purpose of a DSCU is to
care for residents with dementia in the long term.
•
This definition is intended to:
–
Minimize the use of a DSCU as a catch‐all unit for residents with
behavioral health diagnoses
–
Prevent units from advertizing specialized care without meeting the
standards
![Page 11: Implementation of Minimum Standards for Dementia Special ...blog.mass.gov/publichealth/wp-content/uploads/sites/11/2013/08/PHC... · Implementation of Minimum Standards for Dementia](https://reader031.vdocument.in/reader031/viewer/2022030412/5a9e0bef7f8b9a4a238df5e6/html5/thumbnails/11.jpg)
Slide 11
Definitions
Direct care worker:–
A staff member whose work involves extensive patient contact or
administrative decisions regarding care.
–
Not be limited to those workers employed by the nursing home; includes
contracted workers who provide direct care to residents.
–
Includes, but is not limited to: the medical director, registered nurses,
licensed practical nurses, nurse practitioners, physician assistants, certified
nurse aides, activities personnel, feeding assistants, social workers, dietary
aides, and all occupational, physical, and speech therapy staff.
•
This definition is intended to ensure that all staff that interact with the
patients – not just medical staff–
are trained on how to care for patients
with dementia
![Page 12: Implementation of Minimum Standards for Dementia Special ...blog.mass.gov/publichealth/wp-content/uploads/sites/11/2013/08/PHC... · Implementation of Minimum Standards for Dementia](https://reader031.vdocument.in/reader031/viewer/2022030412/5a9e0bef7f8b9a4a238df5e6/html5/thumbnails/12.jpg)
Slide 12
Definitions
Relevant Staff Members means direct care workers, therapeutic activity directors and supervisors of
direct care workers.
•
These three types of employees are required by statute to undergo dementia‐specific training
•
DPH uses the term “relevant staff members”
for administrative simplification
![Page 13: Implementation of Minimum Standards for Dementia Special ...blog.mass.gov/publichealth/wp-content/uploads/sites/11/2013/08/PHC... · Implementation of Minimum Standards for Dementia](https://reader031.vdocument.in/reader031/viewer/2022030412/5a9e0bef7f8b9a4a238df5e6/html5/thumbnails/13.jpg)
Slide 13
Training Standards
Type of
TrainingRequired Staff
Number
of HoursWhen It Must
OccurAdditional
Requirements
InitialAll Relevant
Staff Members8
Before the staff
member
provides direct
care in the
nursing home
1.
Competency
evaluation
2.
At least
partially
interactive
OngoingAll Relevant
Staff Members4
Each calendar
year
1.
Competency
evaluation
2.
At least
partially
interactive
![Page 14: Implementation of Minimum Standards for Dementia Special ...blog.mass.gov/publichealth/wp-content/uploads/sites/11/2013/08/PHC... · Implementation of Minimum Standards for Dementia](https://reader031.vdocument.in/reader031/viewer/2022030412/5a9e0bef7f8b9a4a238df5e6/html5/thumbnails/14.jpg)
Slide 14
Training Standards
•
Existing facilities are given time to come in to compliance with
training requirements for currently employed staff:–
90 days for Dementia Special Care Units–
180 days for traditional nursing homes
•
Training must cover the foundations of dementia and
dementia care, and other topics as specified in guidelines–
Sample topics: •
Communication•
Habilitation Therapy•
Purposeful Engagement
•
Training is portable: relevant staff do not need to be retrained
in the same calendar year if they change facilities
![Page 15: Implementation of Minimum Standards for Dementia Special ...blog.mass.gov/publichealth/wp-content/uploads/sites/11/2013/08/PHC... · Implementation of Minimum Standards for Dementia](https://reader031.vdocument.in/reader031/viewer/2022030412/5a9e0bef7f8b9a4a238df5e6/html5/thumbnails/15.jpg)
Slide 15
Activities Program
•
A DSCU shall have a therapeutic activity director
•
The DSCU must provide a minimum of eight hours of
scheduled therapeutic activities programming per day, seven
days per week.
•
The activities program must:
–
Ensure that activities are planned throughout the day and evening
–
Incorporate the possible need for programming during night hours
–
Ensure that activities are individualized and designed to improve or maintain
residents’
self‐awareness and level of functioning
![Page 16: Implementation of Minimum Standards for Dementia Special ...blog.mass.gov/publichealth/wp-content/uploads/sites/11/2013/08/PHC... · Implementation of Minimum Standards for Dementia](https://reader031.vdocument.in/reader031/viewer/2022030412/5a9e0bef7f8b9a4a238df5e6/html5/thumbnails/16.jpg)
Slide 16
Physical Design
•
Must encompass the entirety of a nursing care unit
•
Must include at least 27 square feet per bed of common space
•
Visitors or staff shall not have to pass through the unit to reach
other areas of the facility.
•
Must have secured outdoor space and walkways
•
A DSCU shall meet specific standards relative to Safety,
Finishing, Lighting, Noise Control and Egress Control
![Page 17: Implementation of Minimum Standards for Dementia Special ...blog.mass.gov/publichealth/wp-content/uploads/sites/11/2013/08/PHC... · Implementation of Minimum Standards for Dementia](https://reader031.vdocument.in/reader031/viewer/2022030412/5a9e0bef7f8b9a4a238df5e6/html5/thumbnails/17.jpg)
Slide 17
Disclosure Form
•
Each DSCU must complete a disclosure form each calendar
year.
•
Goal is to inform consumers and the Department about the
specialized services, beyond regulatory minimums, that the
DSCU provides
•
Form must be submitted to:–
The Department
–
Each resident or the resident’s authorized representative, seeking to be
admitted to the DSCU prior to the resident’s admission; and
–
Any member of the public who requests a copy of the disclosure statement.
•
The disclosure form must also be posted in a public,
conspicuous place within the nursing home.
![Page 18: Implementation of Minimum Standards for Dementia Special ...blog.mass.gov/publichealth/wp-content/uploads/sites/11/2013/08/PHC... · Implementation of Minimum Standards for Dementia](https://reader031.vdocument.in/reader031/viewer/2022030412/5a9e0bef7f8b9a4a238df5e6/html5/thumbnails/18.jpg)
Slide 18
Next Steps
![Page 19: Implementation of Minimum Standards for Dementia Special ...blog.mass.gov/publichealth/wp-content/uploads/sites/11/2013/08/PHC... · Implementation of Minimum Standards for Dementia](https://reader031.vdocument.in/reader031/viewer/2022030412/5a9e0bef7f8b9a4a238df5e6/html5/thumbnails/19.jpg)
Slide 19
Next Steps
•
DPH will hold a Public Hearing in September of 2013
•
DPH will return to the PHC for final promulgation
![Page 20: Implementation of Minimum Standards for Dementia Special ...blog.mass.gov/publichealth/wp-content/uploads/sites/11/2013/08/PHC... · Implementation of Minimum Standards for Dementia](https://reader031.vdocument.in/reader031/viewer/2022030412/5a9e0bef7f8b9a4a238df5e6/html5/thumbnails/20.jpg)
Slide 20
Serious Incident Reports and Disaster Plans
![Page 21: Implementation of Minimum Standards for Dementia Special ...blog.mass.gov/publichealth/wp-content/uploads/sites/11/2013/08/PHC... · Implementation of Minimum Standards for Dementia](https://reader031.vdocument.in/reader031/viewer/2022030412/5a9e0bef7f8b9a4a238df5e6/html5/thumbnails/21.jpg)
Slide 21
Proposed Amendments
![Page 22: Implementation of Minimum Standards for Dementia Special ...blog.mass.gov/publichealth/wp-content/uploads/sites/11/2013/08/PHC... · Implementation of Minimum Standards for Dementia](https://reader031.vdocument.in/reader031/viewer/2022030412/5a9e0bef7f8b9a4a238df5e6/html5/thumbnails/22.jpg)
Slide 22
Serious Incident Reports
•
Technical change that will require LTCFs
to use the newly‐
developed web‐based Health Care Facilities Reporting System
(HCFRS) in place of fax or mail
•
Simplifies reporting for facilities
•
Improves HCQ’s
processing of incident reports
•
Cost to facilities should be minimal –
All CMS‐certified facilities must have a computer to meet federal
requirements
–
HCQ conducted a poll of all rest homes and confirmed they all have
access to a computer
![Page 23: Implementation of Minimum Standards for Dementia Special ...blog.mass.gov/publichealth/wp-content/uploads/sites/11/2013/08/PHC... · Implementation of Minimum Standards for Dementia](https://reader031.vdocument.in/reader031/viewer/2022030412/5a9e0bef7f8b9a4a238df5e6/html5/thumbnails/23.jpg)
Slide 23
Disaster Plans
•
Ongoing collaboration with the Department’s Emergency Planning
Bureau, MassSenior
Care and LeadingAge Massachusetts since 2005 to
improve the emergency disaster infra‐structure for the long term care
industry
•
Immediate communication is critical in order to support facilities
experiencing an emergency or disaster
•
The Department’s Health and Homeland Alert Network (HHAN) proved to
be a critical communication tool during disaster drills
•
Proposed amendments would require all LTCFs
(including rest homes) to
register with HHAN.
•
A facility would only need access to a telephone, cell phone or computer
to receive calls or an email‐issued HHAN message.
![Page 24: Implementation of Minimum Standards for Dementia Special ...blog.mass.gov/publichealth/wp-content/uploads/sites/11/2013/08/PHC... · Implementation of Minimum Standards for Dementia](https://reader031.vdocument.in/reader031/viewer/2022030412/5a9e0bef7f8b9a4a238df5e6/html5/thumbnails/24.jpg)
Slide 24
Next Steps
![Page 25: Implementation of Minimum Standards for Dementia Special ...blog.mass.gov/publichealth/wp-content/uploads/sites/11/2013/08/PHC... · Implementation of Minimum Standards for Dementia](https://reader031.vdocument.in/reader031/viewer/2022030412/5a9e0bef7f8b9a4a238df5e6/html5/thumbnails/25.jpg)
Slide 25
Next Steps
•
Testimony on the Serious Incident Report and Disaster Plan regulations can be given at the
same public hearing as the DSCU standards
•
DPH will return to the PHC for final promulgation