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Thoughts on CMS Focused Dementia Survey from a CDP®

Posted by PCC Institute for Health Professionals on June 22, 2017

Originally published in Connie Ratti’s April 2017 newsletter. Connie is a Certified Dementia Practitioner® Trainer and Certified Therapeutic Recreational Specialist and instructor of Alzheimer’s Disease and Dementia Care.

Dementia care.jpgRecent studies show that 40% of Activity Programing and Implementing are not currently passing survey standards nationwide. As good Activity Professionals, you probably are doing everything you should be doing to successfully pass this phase of the survey. Just in case you are not, I will share the most proven suggestions to help you succeed. Dementia Units that have good activity programming in place and use cultural change and person-centered care have reduced routine medication use by 11%, reduced medication for bowel management by 40%, reduction of anti-anxiety medication by 50%, reduced sedative hypnotics by 50%, have a 50% increase in activity levels and a 100% in social interactions. Long Term Care Units have had a 33% reduction in PRN medication for anxiety and depression, a 44% decrease in staff absenteeism, a 60% reduction in in- house decubitus ulcers, a decrease of 25% in bedfast residents, and a decrease of 18% in the of restraints when person centered care methods were used with meaningful activity programs and environmental changes that eliminated institutional environments.

How and Why the CMS Focused Dementia Survey Originated

In 2014, the Center for Medicare and Medicaid Services (CMS) completed a pilot project to examine the process for prescribing antipsychotic medications and assessment of federal requirements related to dementia care practices in nursing homes. In 2015, an expansion of the Focused Dementia Survey involved a more intensive, targeted effort to cite poor dementia care and the overutilization of antipsychotic medication. So, some examples that they found were:

  • Residents were often misdiagnosed/ receiving antipsychotic medications
  • Residents were found wearing the exact same clothes for five days in a row
  • Many residents were not being interacted with
  • Residents did not have meaningful activities or activities that related to their skill levels
  • Residents were not being engaged with during meals with conversations while staff discussed their personal lives, resident were not offered choices either verbally or option to choose by a non-verbal method.

We know that this is not supposed to happen in our communities, but it does. And really, when it is not corrected it becomes the norm for staff. Before you know it, staff reply “he/she is always that way” or “he/she really can't decide”.

On several occasions, I have asked surveyors “how do you really know that a facility is a good one or has good quality care when you're not here?” These were some of their answers:

  • The community has a really pleasant and happy feel.
  • There is no tension between staff they really work well together - they work in teams.
  • They really know what to do and what residents really need and when.
  • Residents have things to do that they enjoy, or are meaningful and not just routine or busywork.
  • Residents feel the staff knows them and they know the staff. “That's when you really know that the facility is like this all the time, you can't just make this happen for the week we are here, you really know that these patterns are practiced all the time because it is really natural not just a forced effort.”

The results of Focused Dementia Care Study are still a work in progress in partnership with the Advancing Excellence in America's Nursing Homes Campaign and the National Partnership to Improve Dementia Care in Nursing Homes, CMS GPRA goals, Qualify First, the Campaign for Quality Care and the culture change movement. But it would really help you know what the surveyors are looking at by going to the CMS website and type in Focused Dementia Care Surveyor Worksheet or the F309 compliance with regulations 483.25. and some of the things are watching for.

Key Things to Look for on the Focused Dementia Care Surveyor Worksheet

As an Activity Professionals do you know:

  • The diagnosis of different dementia?
  • The policies and procedures for dementia care?
  • How implement good practices when working with dementia residents?
  • If an adequate interview was done to assess previous life patterns, choices, cultural patterns, preferences, sleeping patterns, food desires, exercise, hobbies, etc? Is there evidence present that supports activities based on the resident's known hobbies, routines and life patterns?

As a recreational staff member:

  • Have you received dementia care training?
  • Do you have an understanding of behaviors as a form of communication and do you understand the meaning behind these behaviors?

These are just some key areas to focus on. I’ve seen that with this focus the residents benefit. Some challenges to can be staff is not willing or strong enough in their leadership skills to suggest, remind, and insist that these practices be implemented. But think, if you were the resident wouldn't you want it done that way? Is it so hard to implement these guidelines? How much effort does it really take to be social at dinner with a resident who is cognitively impaired? It only takes a second, and it creates a moment of pleasure and trust and reassurance, even if the conversation is not totally understood, the feeling of trust is communicated; that can help to displace lack of trust and fear when you interact with that person in a different situation.

I strongly encourage all Activity Professionals to take the Dementia Care Training Class, and OAP-ODP is committed to offering these class at a reduced rate to ensure that all Activity Professionals are reaching their residents and the residents are enjoying each day.

All information in this commentary was taken from the CMS website: Focus Dementia Care Survey Tools: Ref: S&C:16-04-NH; Focused Dementia Care Surveyor Worksheets; F-tag 309; the 2016-2017 Nursing Home Action Plan. All opinions expressed by the author are drawn from personal experiences.

Topics: Healthcare, Aging Adult

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