Menu
Login
Specialized Information for:
Nursing HomesAssisted Living/Board & Care Home and Community Based Services
Menu
Login
Specialized Information for:
Nursing HomesAssisted Living/Board & Care Home and Community Based Services
In this issue:
Since the last Ombudsman Outlook issue, there have been additional updates from the Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC). The June issue included a summary of the revised surveyor guidance (effective October 24, 2022). In early July, Consumer Voice published a Reference Guide to help readers understand and access the updated guidance. Highlights of recent federal updates are below.
Nursing Home Ownership Data
On September 26th, CMS announced that additional data regarding ownership of all Medicare-certified nursing homes will be publicly available. Per the CMS press release, “this data will, for the first time, give state licensing officials, state and federal law enforcement, researchers, and the public an enhanced ability to identify common owners of nursing homes across nursing home locations. This information can be linked to other data sources to identify the performance of facilities under common ownership, such as owners affiliated with multiple nursing homes with a record of poor performance.”
Key Points
Updated Nursing Facility Regulations
On August 3, 2022, the Center for Medicare & Medicaid Services (CMS) published updated nursing homes regulations, which included changes to the requirements for the Director of Food and Nutrition Services and updates to the Life Safety Code. CMS also announced changes to the Skilled Nursing Home Quality Reporting Program (QRP) and the Value Based Purchasing Program (VBP).
CMS revised the regulation to state that the Director of Food and Nutrition Services must have “two or more years of experience in the position of director of food and nutrition services in a nursing facility setting and has completed a course of study in food safety and management, by no later than October 1, 2023.” Unlike the 2019 proposed regulation, the new qualification requirements cannot be met by having taken a course of study alone but must be accompanied by two years of experience as the director of food and nutrition services.
Additionally, CMS finalized 2019 proposed changes to 42 C.F.R. §483.90(a), the Life Safety Code. The new regulations allow long term care facilities, certified before July 5, 2016, to use an alternative scoring system to meet fire safety requirements. CMS noted that allowing this system does not lower facility safety standards.
CMS adopted several additional measures for the Value Based Purchasing Program (VBP). The program seeks to incentivize good care through a variety of measures that financially reward nursing homes for good performance.
The new measures include:
Nursing Facility Staffing Study
Earlier this year, President Biden announced a comprehensive set of reforms to improve safety and quality of nursing home care. One of the reforms is to establish new minimum staffing requirements, ensuring that every nursing home has sufficient staff who are adequately trained.
Central to CMS’ goal of establishing a minimum staffing standard is a multi-faceted staffing study to be conducted by CMS. In the August 22, 2022 blog post, CMS laid out its plan for the staffing study which includes:
1. Literature review: a review of existing studies and information to summarize the relationship between care quality and safety and staffing levels.
2. Site visits to nursing homes and related analyses: CMS will visit 50 to 75 nursing homes to interview staff and residents regarding staffing levels and care. In addition, CMS will be collecting observational data on care provisions to develop a simulation model to document the impact of different staffing levels on care quality. The goal, as stated by CMS, is to document not just what staffing levels currently exist, but what levels are needed to meet all residents’ needs.
3. Quantitative analyses: CMS will study payroll data from nursing homes from 2018-2021 to identify staffing levels associated with better care.
4. Cost analyses: CMS will use the data collected in the previous steps to attempt to ascertain the additional costs, if any, of a minimum staffing standard.
Related to nursing home staffing, the Consumer Voice published a report titled, High Staff Turnover: A Job Quality Crisis in Nursing Homes.
Centers for Disease Control and Prevention (CDC)
The CDC updated its infection prevention and control (IPC) guidance.
Key points to the most recent IPC guidance updates include:
To address the updated IPC guidance, CMS published revised memos for visitation and testing on September 23, 2022:
NEW! Virtual Office Hour
NORC is hosting a virtual office hour the last Wednesday of each month at 2:00 pm ET. We will focus on volunteer management for the first few months. These Zoom calls do not include a structured presentation and are open to State Ombudsmen and their program representatives. It is an opportunity for Ombudsman program representatives to ask questions, share information, and have open conversations. These calls will not be recorded. We invite all State Ombudsmen and program representatives to attend and ask us your burning questions about volunteer management. The next call will be October 26 at 2:00 pm ET, use this Zoom link to join.
NEW! Technical Assistance (TA) Talk Materials on the National Ombudsman Reporting System (NORS)
To increase direct access to technical assistance (TA) and peer support, NORC hosts quarterly live technical assistance dialogues. The September 21 TA Talk discussed National Ombudsman Reporting System (NORS), view the recording and materials here. The next TA Talk will be in December 2022. Have questions, an idea for a future topic, or examples of training, consumer education, or successful advocacy? Email NORC at ombudcenter@theconsumervoice.org.
NOTE: We apologize for the limited capacity during the NORS Technical Assistance (TA) Talk on September 21st. For those unable to join the TA Talk, we are hosting a live NORS Q&A on Thursday, October 13, 2022 from 3:00 - 4:00 pm ET. Join NORC and Beverley Laubert, National Ombudsman Program Coordinator, ACL, for a live hour-long discussion to answer your NORS-related questions. To see if some of your questions were addressed, watch the TA Talk recording before tuning in for this Q&A. Register now!
NEW! Webinar Recording and Materials on Long-Term Care Ombudsman Program and Adult Protective Services Collaboration
This webinar discussed how Long-Term Care Ombudsman programs (LTCOP) and Adult Protective Services (APS) can work together to better serve people living in long-term care facilities. Programs from three states shared how their collaboration enhanced staff and community partners' knowledge about each program, provided training regarding sexual abuse and exploitation of long-term care residents, and assisted individuals involuntarily discharged from facilities.
NEW! Webinar Recording and Materials on Advocating for LGBTQ+ Residents
This webinar served to equip attendees with an understanding of the challenges LGBTQ+ residents face, build familiarity with federal, state, and local policy, and help attendees walk away with resources on LGBTQ+ inclusion, such as the new Long-Term Care Equality index (LEI), a national LGBTQ+ benchmarking tool. Thanks to speakers, Dan Stewart, Associate Director, the Aging Equality Project, Human Rights Campaign Foundation, and Sherill Wayland, Director, Special Initiatives, SAGE.
NEW End of Grant Year Wrap-Up
As we finished the last grant year in June 2022, we would like to thank you for sharing your experiences, resources, expertise, and ideas with us. We are able to support Ombudsman programs thanks to funding from the Administration for Community Living/Administration on Aging (ACL/AoA) for the National Consumer Voice for Quality Long-Term Care (CV) to operate the National Long-Term Care Ombudsman Resource Center (NORC). Read highlights of resources and activities completed by NORC over the past year.
What Rights Do Residents Have Regarding Voting and How Can the Ombudsman Program Support Their Right to Vote?
With election season quickly approaching, it is important for Ombudsman programs to promote residents’ right to participate in the election process as residents often experience barriers in voting. Below are resources to help raise awareness about residents’ right to vote, information about facility requirements to support residents’ right to vote, and tips for ensuring voting access.
Know the Laws in Your State
Share Your State Information
Don’t Forget Your Role
Resources
New Training PowerPoints
NORC created NORS Training PowerPoints to accompany the other training materials (e.g., Basic Principals, Quiz, Quiz Answers). Visit the NORS Training page to download the PowerPoints and other materials. The training materials were updated to be consistent with revisions in the NORS Tables (effective October 1, 2021), so check the NORS Training page frequently to ensure you are using the most recent version.
New NORS Frequently Asked Questions (FAQs)
New and updated NORS FAQs have been added to the NORC website. Visit this page to help you find answers to common questions. Some of the new FAQs were shared during the recent Technical Assistance (TA) Talk. If you have an idea for a new FAQ, please email ombudcenter@theconsumervoice.org.
Live NORS Q&A – Thursday, October 13, 2022 – 3 – 4 ET
We apologize for the limited capacity during the NORS Technical Assistance (TA) Talk on September 21st. For those unable to join the TA Talk, we are hosting a live NORS Q&A.
Join NORC and Beverley Laubert, National Ombudsman Program Coordinator, ACL, for a live hour-long discussion to answer your NORS-related questions. To see if some of your questions were addressed, watch the TA Talk recording before tuning in for the Q&A.
Join us for the NORS Q&A and register now!
Ohio Long-Term Care Ombudsmen are Interviewed on Reliable Transportation Needs for Residents
Bob Vines, Managing Ombudsman at ProSeniors in Cincinnati, Ohio was interviewed by WCPO News on the challenges long-term care residents face regarding access to safe, timely, quality, and reliable transportation especially when it comes to medical appointments. Read the full article »
Arkansas State Ombudsman, Charlotte Bishop, Is Interviewed for a Q&A Article on the Ombudsman Program
Arkansas State Ombudsman, Charlotte Bishop, is interviewed for a Q&A article about the long-term care Ombudsman program for the Healthcare Journal of Arkansas. She answers questions about why she became an Ombudsman, the challenges the program faces, and how program representatives can help long-term care residents. Read the full article »
Ohio Long-Term Care Ombudsmen Discuss Their Work on a Television Broadcast
Victoria Brownfield and April Held from the Ohio Long-Term Care Ombudsman program talk about their work as Ombudsman Specialists on a television broadcast with WKYC Studios. Watch the full broadcast »
The Maryland Long-Term Care Ombudsman Program Worked with the Attorney General in the Sentencing of an Operator of Unlicensed Assisted Living Facilities
The Maryland Attorney General, Brian E. Frosh, announced that an operator of unlicensed assisted living facilities was sentenced for felony theft. The Attorney General worked with the Maryland Long-Term Care Ombudsman Program on this case. The operator was sentenced to three years of incarceration, and five years of supervised probation. He was also ordered to refrain from operating any assisted living facilities, have no contact with former residents, and pay $19,379.09 in restitution, of which $17,000 has already been paid. Read the full article »
A Video on Louisiana's Program for Empowering Every Resident (PEER)
Hear residents from St. Jude's Nursing Home in New Orleans, LA talk about LA PEER. A program created to give residents tools and resources to assist other residents at the facility when issues arise. Watch the video »
Rhode Island State Ombudsman, Kathy Heren, Writes a Blog on Voting Rights in Long-Term Care Facilities
With election season just a few short months away, Rhode Island State Long-Term Care Ombudsman, Kathleen Heren, writes a blog for the Connelly Law Offices to remind readers about the voting rights of long-term care residents. Read the blog »
Texas State Ombudsman, Patty Ducayet, is Quoted on Long-Term Care Staffing
Texas State Ombudsman, Patty Ducayet, was interviewed by KXAN.com on long-term care staffing. She told stories of residents having to wait for a bath or to get out of bed, poorly maintained HVAC systems affecting staff and residents’ quality of life, and facility vehicles sitting in disrepair instead of being used for resident activities and appointments. Read the full article »
According to the minimum training standards established by the Administration for Community Living (ACL), Ombudsman program representatives (paid and volunteer) are required to complete 18 hours of in-service training annually.
Do you need more in-service/continuing education training ideas to help your volunteer representatives obtain the minimum 18 hours? Visit the NORC training page and use the NORC resources mentioned in this list to help fill these requirements.
Have Questions about Volunteer Management? Join our Virtual Office Hour
Last Wednesday of each month at 2:00 pm ET | Join using this Zoom Link
NORC is hosting a virtual office hour the last Wednesday of each month at 2:00 pm ET. We will focus on volunteer management for the first few months. These Zoom calls do not include a structured presentation and are open to State Ombudsmen and their program representatives. It is an opportunity to ask questions, share information, and have open conversations. These calls will not be recorded. We invite all State Ombudsmen and program representatives to attend and ask us your burning questions about volunteer management.
Emergency preparedness and response is even more important as the frequency and intensity of natural disasters increase. This article highlights the role of the Ombudsman program in emergency preparedness.
The Role of the Ombudsman Program
Ombudsman programs play a vital role in emergency planning and response. Ombudsman programs resolve complaints, protect rights, and promote access to services for residents before, during, and after emergencies and disasters. There are a variety of ways in which Ombudsman programs can contribute to ensuring that long-term care facilities are ready for natural disasters.
Examples of Ombudsman program activities and advocacy regarding emergency preparedness:
Tips for Emergency Preparedness
CDC Tips on Preparing for a Hurricane or Tropical Storm
The Center for Disease Control and Prevention (CDC) provides the following tips for preparing for a hurricane or tropical storm. Read the full list on their website.
Emergency Preparedness Resources
Long-Term Care Ombudsman Program Role in Emergency Preparedness and Response: The Basics (February 2022)
These training materials provide a basic training regarding the LTCOP role emergency preparedness and response. The materials may be used in initial certification training or in-service (continuing education) training. The training materials include a PowerPoint and a video. Ombudsman programs may customize the PowerPoint with specific state and/or local information. The content is the same in both resources; however, you may use them differently as described in the training instructions.
Webinar Materials - Are You Ready? Ombudsman Program Emergency Preparedness and Response (February 23, 2022)
During this webinar (recording and PowerPoint) participants learned how Ombudsman programs may better serve residents of long-term care facilities by being prepared for emergencies and how to best respond to them.
Being Prepared! Things Ombudsmen Should Do Before, During and After an Emergency
This guide breaks down steps that Ombudsmen can take before, during, and after emergencies. It also provides personal safety and work safety guidelines.
Smartphone Apps for Ombudsmen
This resource is a list of suggested weather and emergency related applications for Ombudsmen to download to their iPhone or Android devices.
Emergency Preparedness: Questions Consumers Should Ask
This fact sheet from Consumer Voice provides a list of questions consumers should ask regarding the facility’s emergency preparedness and evacuation plans.
For more information on Emergency Preparedness visit the NORC website.
October is Residents’ Rights Month, an annual event designated by Consumer Voice to honor residents living in all long-term care facilities and those receiving care in their home or community. It is an opportunity to focus on and celebrate the dignity and rights of every individual receiving long-term services and supports.
Being a part of a community is essential to our well-being. Throughout the pandemic, residents of long-term care facilities were disconnected from the resident and staff communities within their facilities when activities and group dining were limited. Residents were disconnected from the broader local community when visitation was restricted, and many residents were unable to leave their facilities to participate in outside activities.
This year's Residents’ Rights Month theme - Inspiring Unity within Our Community - emphasizes the importance of fostering meaningful community within the facility and encouraging residents’ connection to their local community. Visit the Consumer Voice website for activity ideas, promotional materials, resources, and products.
Resident's Voice Challenge
For this year's Resident’s Voice Challenge, residents were encouraged to submit essays, poems, artwork, drawings, or videos related to the theme. See the 2022 resident submissions.
October 2022: Residents' Rights Month - Learn more »
October 13, 2022: NORS Q&A | 3:00 - 4:00 pm ET - Learn more »
November 14-16, 2022: Consumer Voice In-Person Conference at the Lord Baltimore Hotel - Learn more »
December 8-9, 2022: Consumer Voice Virtual Conference - Learn more »
December 14, 2022: Save the Date - Quarterly Technical Assistance (TA) Talk – Topic TBD | 3:00 - 4:00 pm ET
Last Wednesday of Each Month: Virtual Office Hour - Learn more »
Consumer Voice Voting Issue Page