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 CMS Expands Dementia Care Survey Project

The Centers for Medicare & Medicaid Services (CMS) has released its final report on the Focused Dementia Care Survey Pilot it conducted last summer. The project was a follow-up to a CMS and industry effort to improve care by expanding the use of nonpharmacological approaches and reducing the off-label use of antipsychotic medications in long-stay nursing home residents.
Five states (California, Minnesota, New York, Illinois, and Louisiana) participated in the pilot. Between the months of July and September in 2014, each state completed four focused surveys and an observation visit. The partnership surveyed 20 total nursing centers—five from each state, with one considered by the state a “best-practice” center and four others. Notable results from the pilot include:
·         Of the 20 centers surveyed, 16 were cited at either F309 (Care of a Resident with Dementia) or F329 (Unnecessary Use of Medications).
·         Both F309 and F329 tags were cited in 11 of the 20 centers.
·         Of the 68 total deficiency citations, four were at a G or harm level (three in California and one in Illinois.
Those surveyed found the dementia-focused survey to be a “positive and valuable learning experience,” says CMS. Some wanted more preparation and training related to the survey and process. Many found the survey to be time-intensive but better at identifying and citing deficient practice than the standard annual or complaint surveys.
Several surveyors suggested eliminating the closed record review in an effort to streamline the survey. A majority of surveyors thought either some of the survey questions should be implemented into the annual survey process or the survey should remain as a stand-alone survey to be conducted at the discretion of the state agency or CMS.
This year’s expansion project will incorporate a revised version of the survey in both traditional and quality indicator survey (QIS) states. CMS plans to use a streamlined version of dementia care-focused worksheets and processes during complaint surveys in several states. The agency is working with the Central Office training division and state agency training coordinators to integrate the lessons learned from the pilot into ongoing orientation and training efforts. Other issues that remain to be addressed, according to CMS, include management of pain symptoms, decisionmaking, and caregiver stress.
The partnership has revised its antipsychotic drug use goal to a 30 percent reduction by the end of 2016. In February, the agency added two quality measures on antipsychotic use (one for long-stay, one for short-stay) to the algorithm it uses to calculate each nursing home’s quality measure score on the Five-Star Quality Rating System.
CMS will provide criteria for determining specific facilities to be surveyed and will work with the states to identify dementia care experts to accompany surveyors for the first survey. Any deficiencies observed during the surveys will result in relevant citations. So far, Texas has agreed to participate.
States interested in participating should email dnh_behavioralhealth@cms.hhs.gov and plan to join a conference call that will take place this summer.
Jackie Oberst is Provider’s managing editor. Email her at joberst@providermagazine.com.
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