CMS Guidelines Call for More Homelike Environments

The Federal and State surveyors showed up at our Kahului community this morning, so I thought that today would be as good a day as any to write about some of the changes in the Centers for Medicare and Medicaid Services (CMS) guidelines that support our efforts in creating more homelike environments through both physical environmental changes and resident-centered caregiving. The new guidelines, which went into effect on June 17, 2009, call on nursing homes to begin/continue de-institutionalizing their physical environments. CMS suggestions include:

• Eliminating overhead paging and bed/chair alarms
• Refraining from having meal service in dining rooms using trays
  
• Removing institutional signage
• Eliminating medication carts
• Reducing mass purchased furniture, drapes and bedspreads
• Eliminating large, centrally located nursing stations

It is important to note that the above are only some suggestions provided by CMS, however if a nursing home does not meet these suggestions, they will not be considered non-compliant. According to the CMS guidelines a nursing home "is expected to do all it can within fiscal constraints to provide an environment that enhances quality of life for residents, in accordance with resident preferences" (F252).

CMS memo issued on April 10, 2009, which include its new interpretive guidelines for surveyors, states: "A 'homelike' or homey environment is not achieved simply through enhancements to the physical environment. It concerns striving for person-centered care that emphasizes individualization, relationships, and a psychosocial environment that welcomes each resident and makes him/her comfortable."

In addition, new CMS guidelines also call for visitors to have 24-hour access to residents, regardless of their familial relationship. I am happy to be able to say that visiting hours and visitor sign in books at both of our nursing communities were eliminated over three years ago as part of our initial Luana efforts.

These new CMS guidelines are the result of the symposium hosted by CMS and the Pioneer Network in April 2008, which focused on the impact of innovative environmental design on creating a home and community for nursing home residents. If you are interested reading the background paper from this symposium, please click on the below link:
Creating a Home in the Nursing Home: A National Symposium on Culture Change and the Environment Requirements