MESSAGE
| DATE | 2020-05-04 |
| FROM | Ruben Safir
|
| SUBJECT | Subject: [Hangout - NYLXS] Nursing Homes Atrocity
|
Our nursing homes were commanded by the state to accept Wuhan(COVID)-19
patients knowing that these institutions don't have the personel or the
equiptment to deal with outbreaks of this virus in the homes and knowing
the large motality rate among this population. The governors office
made this demand directly. The result was a near wipe out of many of
these homes. Nirsing homes beged the state to move elderly patient out
of harms way. The state refused to quarantine or to move patients.
This is an example of gasoline on the fire and is a prime example of why
the state can not be expected to protect us or make rational decisions
for our safety through this epidemic.
To further prove how impossible it is to trust these peoples judgement,
you need to read the responce by CMS. When you read what kind of
useless and fantasy like response CMS made, you then understand why we
are uselessly locked in our homes. These people don't operate with even
urgancy of care about the people they hurt.
When you see 6% mortality rates to diagnosed cases, it is essential to
understand why. It is not your doctor, or the nurses, or the spread,
but your Governor and the government.
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https://www.cms.gov/blog/ensuring-safety-and-quality-americas-nursing-homes
Apr 15, 2019
Ensuring Safety and Quality in America’s Nursing Homes
Seema Verma, Administrator, Centers for Medicare & Medicaid Services
Nursing facilities
Quality
Safety
CMS is charged with developing and enforcing quality and safety
standards across the nation’s health care system, a responsibility we
consider a sacred trust. While we support and promote the private
sector’s critical role in our health care system, CMS’ duty to monitor
the safety of the nation’s hospitals, nursing homes, and other
providers, is a unique governmental task which lies at the core of
government’s role in health care. This duty is especially important when
it comes to the care provided for some of the most vulnerable in our
society, Americans residing in nursing homes.
Every nursing home resident deserves to retain their basic human dignity
and to be treated with respect at all times. Abuse and neglect are never
acceptable. CMS’ approach to oversight of nursing homes is constantly
evolving. Just as we’re unleashing innovative strategies and
technologies in other areas of CMS, we’re continuously looking for ways
to improve our approach to nursing home safety and quality. We must
never be complacent – we should always push ahead to continuously
improve our efforts.
CMS is not waiting, and not settling for the status quo: I have directed
my team at CMS to undertake a comprehensive review of our regulations,
guidelines, internal structure, and processes related to safety and
quality in nursing homes. America deserves nursing homes that ensure
residents are treated with dignity and kept safe from abuse and neglect;
that are rewarded for value and quality; whose patient outcomes are
transparent to consumers; all without unnecessary paperwork that keeps
providers from focusing on patients. We have demonstrated our commitment
to this path by developing a five-part plan to ensure the care provided
in America’s nursing homes is of the highest possible quality. While we
pursue these efforts, we welcome interest and input from all
stakeholders, Congress, and our other federal partners. But we have
already started executing our plan, and we’ve got our eyes on the future.
Strengthen Oversight
CMS works in partnership with State Survey Agencies (SSAs) to oversee
nursing homes, since these agencies are generally also responsible for
state licensure. The SSAs visit and survey every Medicare and Medicaid
participating nursing home in the nation at least annually to ensure
they are meeting CMS’ health and safety requirements as well as state
licensure requirements. To be effective, SSAs must be fair and
consistent in applying CMS rules.
In recent years, we have found wide variation across SSAs. Some states
frequently identify serious issues in nursing homes, while others don’t
identify concerns with the same seriousness or severity – including
application of penalties. Residents deserve consistent nursing home
quality, regardless of location, so CMS is revising our oversight of SSA
performance. We’re examining the way surveyors identify issues such as
abuse, facility staffing levels, and dementia care, and we are
clarifying expectations regarding when abuse must be reported to the
State and law enforcement. This means setting clear timelines for SSAs
to review allegations of abuse and neglect. We will also be updating
Nursing Home Compare to make it easier for consumers to identify
specific instances of non-compliance related to abuse or inappropriate
antipsychotic medication use.
We’re also rethinking the guidance we provide to SSAs. When surveyors
determine that a nursing home is providing care poor enough to seriously
harm residents or is likely to cause serious harm– a situation called
“Immediate Jeopardy”– that finding should be based on consistent
application of standards nationwide. Patients must be protected from
dangerously poor quality, no matter where they live. We recently revised
and streamlined the guidelines for determining Immediate Jeopardy used
by surveyors. Going forward, SSAs will be armed with clearer procedures
so, as they conduct their review of each nursing home, dangerous issues
will be discovered and promptly reported to CMS so residents are kept
safe through appropriate enforcement actions intended to bring about
rapid and sustainable compliance. Information about these kinds of
findings and associated enforcement actions are available on Nursing
Home Compare.
Finally, we’re working on new ways to identify abuse and stop it in its
tracks. We’re looking at our organizational structure to enhance
collaboration across our regional staff, who work on the front lines
with providers particularly when serious quality issues like abuse are
identified. We’re exploring the possible use of Medicare claims data and
associated adverse outcomes or indicators, including the use of
artificial intelligence and text mining, to inform our nursing home
survey and oversight process, especially for individuals transferred
from a nursing home to a hospital. Additionally, to help prevent abuse,
we think it is critical to more effectively identify workers with a
history of abuse. While reviewing the feasibility of these steps, we are
strengthening our oversight to ensure that survey findings reflect the
quality of facilities, regardless of their location. We will
continuously strive to ensure all entities that survey nursing homes are
doing so appropriately and consistently.
Enhance Enforcement
CMS enforces the compliance of basic health and safety standards for
nursing homes to ensure patient safety and quality care. Here, too,
we’re working to improve. We’re strengthening our enforcement policies
to hold nursing homes accountable for the care they provide. As part of
this effort, we’re developing new ways to root out bad actors and repeat
offenders.
CMS has long identified staffing as one of the vital components of a
nursing home’s ability to provide quality care. CMS collects staffing
data from nursing facilities through the PBJ system based on payroll and
other verifiable and auditable data, as required by law. Since November
2018, CMS has shared this data with SSAs so they know which nursing
homes may have potential staffing problems and can target their reviews.
SSAs are conducting a portion of their unannounced after-hours and
weekend inspections to focus on staffing problems during those times.
SSAs will take appropriate enforcement actions against those facilities
that fail to provide the required nurse staffing.
We’re also improving quality of life for nursing home residents. Too
often, residents with dementia-related psychosis have been deemed to be
unruly or difficult, and have been given antipsychotic sedative drugs in
contravention of FDA guidelines. CMS has worked through our National
Partnership to Improve Dementia Care in Nursing Homes to curb the
inappropriate use of these drugs in nursing homes. On March 1st, we
announced enhanced oversight and enforcement of nursing homes that have
not improved their antipsychotic medication utilization rates for
long-stay nursing home residents since 2011, or “late adopters.” We’ve
begun imposing stricter sanctions like denying payment for new
admissions and per-day Civil Money Penalties on late adopters that have
a history of noncompliance with our rules related to chemical
restraints, dementia care, and psychotropic drugs, and have been
determined in a current survey to be out of substantial compliance with
those requirements. CMS and SSAs will be closely monitoring these
facilities to ensure that they achieve and continue to maintain
substantial compliance in these areas.
We’re also committed to working with Congress to strengthen nursing home
enforcement. In President Trump’s Fiscal Year 2020 budget, we’ve asked
Congress to provide us the authority to adjust the frequency of
mandatory nursing home surveys so we can focus more of our time and
resources on nursing homes that are poor performers while continuing
efforts to respond to complaints. The FY 2020 Budget also requests $442
million for Survey and Certification, a $45 million increase from the
previous year. The increased funding would enable CMS to continue to
meet the statutory survey requirements while dealing with the increase
in volume and severity of complaints, and rising survey costs.
Increase Transparency
CMS is empowering consumers, their families, and their caregivers by
giving them the resources they need to make informed decisions, and key
to our effort is our Nursing Home Compare website. Nursing Home Compare
offers a wide variety of data related to nursing home quality. We’re
constantly working to make sure the information on Nursing Home Compare
is as accurate and informative as possible. In April 2018, for example,
we incorporated data on nursing home staffing based from a new
payroll-based journal (PBJ) system into Nursing Home Compare and the
Nursing Home Five-Star Quality Rating System. The new PBJ data allows
CMS to more accurately track staffing levels in nursing homes. Adding
this data to Nursing Home Compare provided an entirely new and key
source of quality information to nursing home residents, their families,
and caregivers. We are continuing to explore other ways to improve
Nursing Home Compare, including highlighting specific quality issues
like abuse or the inappropriate use of antipsychotic medication.
In addition to the transparency resources found on Nursing Home Compare,
we’ve developed further ways to publish more important quality
information. We’ve increased public awareness of nursing homes failing
to meet our minimum health and safety standards. Now, instead of
publishing notices in local newspapers, we’re publicizing instances in
which CMS terminates our agreements with nursing homes due to poor
quality on our website. Additionally, the public should know how we
inspect nursing homes, so we’ve made our Long Term Care surveyor
training available online.
Finally, when a survey finds a nursing home deficient in any way, the
public has a right to know. Surveys of nursing homes generate official
health and safety deficiency reports, which convey important quality of
care findings. Because these reports can be difficult for the public to
understand, we’re working on ways to make them more accessible. We want
them to be clear so the public has full knowledge of the scope and
severity of any problems identified during our nursing home inspections.
We’re doing everything we can to give the public more and better
information so they can make the choice that’s best for them. We’re
committed to transparency, and we will never stop working to give
patients and residents the clearest and most accurate information possible.
Improve Quality
While CMS is holding nursing homes accountable through oversight and
enforcement measures, we’re also actively keeping patients safe by
helping nursing homes improve. We’re doing that by developing quality
measures that score providers based on patient outcomes, not adherence
to processes. We’re also investing in programs that focus on key areas
of nursing home care to help achieve higher quality.
CMS fines nursing homes that don’t comply with our requirements, and we
recently launched an initiative to invest these Civil Money Penalty
(CMP) dollars in efforts to reduce adverse events, improve staffing
quality and improve quality of care for residents with dementia. We’ve
also begun to incorporate value into how we pay for skilled nursing
care. In our Skilled Nursing Facility (SNF) Value-Based Purchasing
Program, a portion of a SNF’s payments is based on performance. We’re
also focusing a significant portion of our clinical quality improvement
work on nursing homes. We developed precise, quantifiable goals to
measure our success in decreasing infections and adverse drug events,
both of which are significant sources of patient harm in nursing homes.
We are focusing on measures that focus on improving patient outcomes
while minimizing burden and through CMS’ Meaningful Measures Initiative
prioritizing those measures through all areas of our work to improve
quality. We’re also investing in programs that take best practices from
high-performers and share them with lower quality facilities.
We’ve already reaped rewards from our quality improvement work. Between
2011 and the third quarter of 2018, for example, our work with the
National Partnership to Improve Dementia Care in Nursing Homes helped
decrease the national prevalence of antipsychotic medication use among
long-stay nursing home residents by 38.9 percent to a national
prevalence of 14.6 percent. This simple step has helped improve quality
of life for nursing home residents nationwide.
We’re not done. We’re unleashing our expertise in quality measurement to
address serious quality issues like healthcare-associated infections,
and we’re looking at how we can better spend CMP dollars on the most
critical quality issues.
Put Patients Over Paperwork
Ensuring access to quality nursing home care is our priority, and it’s a
delicate balance. As we have seen time and again, more regulation is not
necessarily better regulation, nor does it always translate into better
care or outcomes. When administrative burden increases with little or no
benefit, patients suffer because mountains of unnecessary paperwork keep
providers from patients. Additionally, high administrative costs can
make it difficult for facilities to operate. In rural America, a
shuttered nursing home can present serious access to care problems. We
are developing our regulatory strategy in a way that puts patient
quality and safety first while removing unnecessary burdens on providers
that create staffing challenges and increase cost without increasing
quality. We want to make sure providers spend time caring for residents
instead of completing unnecessary paperwork.
Every time we implement a new rule or requirement, we think about
minimizing burden while keeping patients safe. In 2016, CMS issued a
final rule that revised the federal health and safety requirements for
nursing homes for the first time in over 25 years. These changes reflect
substantial advances that have been made over the past several years in
resident care and quality assessment practices. As we continue to
implement this rule, we are keenly focused on minimizing administrative
burden for providers.
Additionally, we helped nursing homes meet an important new requirement
related to infection control. We worked with CDC to develop online
training about infection prevention and control, and offered it to
nursing homes at no cost. Going forward, we will continue to think about
how we can streamline processes and eliminate obsolete, unnecessary, or
duplicative provisions and we are interested in hearing from all
stakeholders on ways to improve our programs.
Finally, if you have knowledge of abuse or neglect in a nursing home,
please alert a supervisor, social worker, administrator, or doctor. You
can also follow the facility’s required grievance procedures. If you
need outside help, you can use our website to find the contact
information for your state’s SSA and Long-Term Care Ombudsman.
We at CMS are personally committed to making sure Americans have access
to the highest-quality nursing home care. This work should never stop.
This is not business as usual – we are pushing beyond the status quo. We
are focused on ensuring America’s nursing homes are keeping residents
safe by rewarding quality and value, making outcomes transparent, and
reducing unnecessary paperwork that detracts from patient care, and we
will not hesitate to use every tool at our disposal to complete our mission.
--
So many immigrant groups have swept through our town
that Brooklyn, like Atlantis, reaches mythological
proportions in the mind of the world - RI Safir 1998
http://www.mrbrklyn.com
DRM is THEFT - We are the STAKEHOLDERS - RI Safir 2002
http://www.nylxs.com - Leadership Development in Free Software
http://www.brooklyn-living.com
Being so tracked is for FARM ANIMALS and extermination camps,
but incompatible with living as a free human being. -RI Safir 2013
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