CMS Rule for Long-Term Care Facilities Speaks to Better Care for Older Americans
“It’s an experience millions of Americans go through each year, the difficult decisions we face when considering a long-term care facility [LTCF] for a loved one. We want to know that our family member will be safe, properly cared for, and receive the highest quality of care.”
That’s how Andy Slavitt, acting administrator for the Centers for Medicare & Medicaid Services (CMS), and Kate Goodrich, MD, MHS, director, Center for Clinical Standards and Quality, CMS, described the agency’s final rule focused on improving care and quality of life in LTCFs. “Reform of Requirements for LTC Facilities,” released October 4, revises the requirements that LTCFs must meet to participate in Medicare and Medicaid.
This rule represents “a major step forward,” as Mr Slavitt and Dr Goodrich noted in a post for the CMS Blog. But more than that, the rule is a step forward, grounded in the insights, recommendations, and expertise of countless geriatrics health care professionals represented by the American Geriatrics Society (AGS). The LTCF rule was one of several regulations reviewed extensively by the AGS in 2015 as part of its ongoing advocacy and public policy efforts. That the final rule is so focused not only on older adults and caregivers but also on the health care professionals committed to their wellbeing is a testament to strategic, Society-based engagement with regulatory partners like CMS.
In initial commentary on the proposed rule from October 2015, the AGS made several important recommendations to balance improved care quality with attention to the “significant unintended consequences” AGS experts identified when reviewing the draft rule. These included suggestions to:
- Clarify language around credentialing requirements for attending physicians;
- Enhance protections against abuse, neglect, and exploitation by looking critically at professionals disciplined for mistreatment of any older individual, not just an LTCF resident as initially proposed;
- Safeguard patient privacy as part of care transition reporting to state officials; and
- Promote thorough, thoughtful, and high-quality care through requirements to develop “baseline care plans,” among several other comments addressing everything from markers for the activities of daily living to proposed conditions for in-person evaluations prior to unscheduled transfers from an LTCF to a hospital.
Not surprisingly, the final rule took many of these recommendations to heart. Among several new milestones, CMS noted that the rule:
- Strengthens the rights of LTCF residents, including prohibiting the use of pre-dispute binding arbitration agreements;
- Ensures that LTCF staff are properly trained on preventing elder abuse and caring for residents with dementia;
- Encourages LTCFs to take the health of residents into consideration when making staffing decisions;
- Promotes the skill sets and competencies needed for person-centered care; and
- Improves care and discharge planning for all residents by facilitating greater interprofessional collaboration and respect for caregiver needs and expectations.
As noted in the Federal Register, the new LTCF rule “reflect[s] the substantial advances that have been made over the past several years in the theory and practice of service delivery and safety.” These advances move from theory to practice, however, because communities of experts like AGS members invest the time, talent, and resources to ensure their voices can be heard.
With more and more proposed regulations on the docket as we move toward more respectful, responsive care, the AGS, its members, and its partners are as poised as ever to ensure geriatrics has the voice—and receives the recognition—it deserves long-term.
