TIP OF THE WEEK

Regulatory Support for Improving the Bathing Experience

 

Would you consider taking a bath in the same manner as residents at your nursing homes do? In many nursing homes across the country, the bathroom is a sterile, institutional environment – a far cry from the luxury of a spa or the comfort of your tub at home. Even some bathing schedules are “institutionalized” when they are based on (or strongly influenced by) the schedule of the previous occupant. With this in mind, it is no wonder that some residents are resistant to taking a bath and physically or vocally express their displeasure, especially those with dementia.

 

Consider the federal regulations related to bathing listed below. You might be surprised that they support changes that improve the bathing experience.

 

REGULATORY SUPPORT

• n 516.2 A minimum of a complete bath twice a week for all ambulatory patients, with adequate assistance or supervision as needed. Patients who are incontinent or are confined to bed shall have a complete bath daily and partial baths each time the bed or clothing is wet or soiled.
• n 516.3 A minimum of one shampoo every week and assistance with daily hair grooming.
• n 516.4 Assistance with or supervision of shaving of men patients at least every other day, except when contraindicated or refused by the patient.
• n F164 Privacy and Confidentiality: Personal privacy includes personal care.
  • (Surveyor Guidance) Facility staff must examine and treat residents in a manner that maintains the privacy of their bodies. A resident must be granted privacy when going to the bathroom and in other activities of personal hygiene.
• n F241 Dignity: The facility must promote care for residents in a manner and in an environment that maintains or enhances each resident’s dignity and respect in full recognition of his or her individuality.
  • (Surveyor Guidance) Are residents groomed as they wish to be (e.g., hair combed and styled, beards shaved/trimmed, nails clean and clipped)?
• Do staff members help residents dress in their own clothes appropriate to the time of day and individual preferences?n F242: Self-Determination and Participation: The resident has the right to choose activities, schedules and healthcare consistent with his or her interests, assessments and plans of care. The resident has the right to make choices about aspects of his or her life in the facility that are significant to the resident.
  • (Surveyor Guidance) Observe how well staff know each resident and what aspects of life are important to him/her. Determine if staff make adjustments to allow residents to exercise choice and self-determination.
• n F310: A resident’s abilities in activities of daily living do not diminish unless circumstances of the individual’s clinical condition demonstrate that diminution was unavoidable. This includes the resident’s ability to bathe, dress and groom.
  • (Surveyor Guidance) Were individual objectives of the plan of care periodically evaluated? If the objectives were not met, were alternative approaches developed to encourage maintenance of bathing, dressing and/or grooming abilities?

MDS

Personal preferences should be communicated with the MDS coordinator and interdisciplinary team to ensure accurate MDS coding in sections such as “Customary Routines” in Section AC and “Physical Functioning” in Section G.

 

To learn more about Person-Centered Care, please go to the Ohio Person-Centered Care Coalition Web page at www.centeredcare.org or register to attend the coalition’s third annual conference Through My Eyes on April 3, 2008 in Columbus Ohio.

 

Use bath time as an opportunity to check skin for
breakdown on residents at risk for pressure ulcers.

 

Source: Portions of this material were prepared by the Arkansas Foundation for Medical Care Inc. (AFMC), the Medicare Quality Improvement Organization for Arkansas.

 

 

 

 

IN THE NEWS

 

FIGHTING BEDSORES WITH A TEAM APPROACH

February 19, 2008 -- NY Times -- A study of a collaborative program involving 52 nursing homes from around the country, including the Elisabeth Prentiss Center in Cleveland and Ohio KePRO, suggests that involving everyone from nurses and nursing assistants to laundry workers, nutritionists, maintenance workers and even in-house beauticians is an important component to reducing pressure ulcers. The Journal of the American Geriatrics Society’s August issue reported that team efforts had reduced the number of severe pressure ulcers acquired in-house by 69 percent. Read more >>

 

 

MEDICARE WON'T PAY HOSPITALS FOR “NEVER EVENTS”

February 19, 2008 -- Associated Press -- Beginning October 1, 2008, Medicare will no longer pay for the extra costs associated with eight preventable hospital “never events,” including catheter-caused UTIs, injuries due to falls, and leaving objects in the body after surgery. Next year, three more “never events” may be added to the list. Private insurance and state Medicaid programs are beginning to follow Medicare’s lead by refusing payment for these in-hopital events. Read more >>

 

 

CMS REPORTS TO CONGRESS ON A FULLY BUNDLED MEDICARE PAYMENT SYSTEM FOR ESRD

February 20, 2008 -- CMS -- Improvements in how Medicare pays kidney dialysis centers could enable them to more efficiently deliver services to Medicare beneficiaries with end-stage renal disease (ESRD), according to a report to Congress by the Centers for Medicare & Medicaid Services (CMS). Read more >>

 

 

OHIO KEPRO EVENTS

 

 

 

INDUSTRY EVENTS

 

Not my Facility! How to handle an allegation of sexual abuse

Presented by the Ohio Academy of Nursing Homes

Tuesday, February 26 in Columbus from 10 a.m. to 3 p.m.

 

CMS Skilled Nursing Facility (SNF)/Long-Term Care (LTC) Open Door Forum

February 27, 2008, 3:30 p.m.

Dial: 1-800-837-1935 & Reference Conference ID: 18796437

 

 

NAVIGATING THE MDS THROUGH THE OHIO MEDICAID REIMBURSEMENT SYSTEM

May 1, 2008, 8:30 a.m. to 4:45 p.m. ET

Speakers: Claire Spellmire, RN, BSN, and Karen Jennings, LNHA, MHA, from the Case Mix Section, Bureau of Long Term Care Facilities, Office of Ohio Health Plans.

Cost: Free

 

For more information or to register, call Cheryl Robertson at (614) 466-9088.

Space is limited to two per facility.

 

Cuyahoga Community College Spring ’08 Continuing Education Schedule for Gerontology Professionals

• March 12, 2008, 9:00 to 4:30 – Incorporating Quality Into Your Everyday Work with Betty Pilous, (Pre-approved by Ohio Social Worker Board, Ohio Counselor Board and BENHA)

Medicare Learning Network: Learning resources and products for the healthcare professional.

 

Alzheimer’s Association Training Events

 

AOPHA Events

 

Case Western Reserve University School of Medicine Courses

 

Ohio Department of Health, Technical Assistance Program – New Programs

 

Ohio Health Care Association Events

 

 

 

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