The Centers for Medicare & Medicaid Services State Operations Manual, appendix PP, provides requirements and interpretive guidance related to the Requirements of Participation for nursing centers, and social and psychosocial needs and services are discussed in numerous places throughout.

“This makes it clear that these needs and this aspect of health is as significant as physical needs and health,” says Sara Rudow, senior director of regulatory services at the American Health Care Association.
Nursing centers are expected to meet social and psychosocial needs of residents in a variety of ways, from care planning processes to activities programs and how they train staff. “The requirements talk often about helping residents attain or maintain their highest practicable well-being—as defined in the State
Operations Manual—and this includes social and psychosocial needs,” says Rudow.

In addition, the requirements related to abuse and neglect prevention, as well as to all sorts of potential adverse events, also emphasize that psychosocial outcomes as just as important as physical ones, she says.

What follows is a nonexhaustive list of sections of the requirements and guidance pertaining to meeting social and psychosocial needs.

■ Safe Environment §483.10(i). The resident has a right to a safe, clean, comfortable, and homelike environment, including but not limited to receiving treatment and supports for daily living safely. The facility must provide— §483.10(i)(1) A safe, clean, comfortable, and homelike environment, allowing the resident to use his or her personal belongings to the extent possible.

Guidance states: A “homelike” 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 her/him comfortable. It is the responsibility of all facility staff to create a “homelike” environment and promptly address any cleaning needs.

■ Quality of Life § 483.24. Quality of life is a fundamental principle that applies to all care and services provided to facility residents. Each resident must receive, and the facility must provide, the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, consistent with the resident’s comprehensive assessment and plan of care.

Definition: “Highest practicable physical, mental, and psychosocial well-being” is defined as the highest possible level of functioning and well-being, limited by the individual’s recognized pathology and normal aging process. Highest practicable is determined through the comprehensive resident assessment and by recognizing and competently and thoroughly addressing the physical, mental, or psychosocial needs of the individual.

■ Activities §483.24(c)(1). The facility must provide, based on the comprehensive assessment and care
plan and the preferences of each resident, an ongoing program to support residents in their choice of activities, both facility-sponsored group and individual activities and independent activities, designed to meet the interests of and support the physical, mental, and psychosocial well-being of each resident, encouraging both independence and interaction in the community.

Intent §483.24(c). To ensure that facilities implement an ongoing resident-centered activities program that incorporates the resident’s interests, hobbies, and cultural preferences, which is integral to maintaining and/or improving a resident’s physical, mental, and psychosocial well-being and independence. To create opportunities for each resident to have a meaningful life by supporting his/her domains of wellness (security, autonomy, growth, connectedness, identity, joy, and meaning).

■ Nursing Services §483.35. The facility must have sufficient nursing staff with the appropriate competencies and skill sets to provide nursing and related services to assure resident safety and attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care and considering the number, acuity, and diagnoses of the facility’s resident population in accordance with the facility assessment required at §483.70(e).

■ Behavioral Health Service §483.40. Each resident must receive, and the facility must provide, the necessary behavioral health care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and plan of care.
Behavioral health encompasses a resident’s whole emotional and mental well-being, which includes, but is not limited to, the prevention and treatment of mental and substance use disorders (see additional guidance under this section, F740).

Source: www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/som107ap_pp_guidelines_ltcf.pdf.