- THCA

Volume XXX, Number 6
June 2015

Focused Dementia Surveys have begun in Texas – Be sure you’re READY!

What we know:

There have been three Focused Dementia Surveys to date that we are aware of. We have heard that the facilities being targeted are at a 40% or higher usage of antipsychotics. Using current data available that means that there are 123 facilities in Texas that could be included in the sample with 31 of those being THCA Members.

Alice Bonner the CMS Dementia Care Expert participated in the first three of 15 anticipated surveys.

Of the two facilities that we have spoken to there was a team of 8 to 12 individuals comprised of CMS staff, DADS State office staff, Ombudsman, DADS QM’s and DADS Surveyors. The surveys have lasted between two and five days depending on findings. During these three surveys Ms. Bonner was training the surveyors on what to focus on for the remainder of the surveys. It is anticipated that all of the first three will have citations recommended mainly focusing on the following four Federal tags:

F 309 Related to Quality of Care;

F 329 Unnecessary Drugs;

F 278 Related to Assessment;

F 279 Related to Care Planning;

With that said the perception from facilities has been that there is such a broad approach that they feel more like an annual survey. Outcomes have led to citations as high as IJ and SQC’s so far.

Surveyors are being trained on looking at dementia care through a new set of lenses. We understand that they are tying everything back to the following main areas:

Policies and Procedures on Dementia Training, ensuring that they are current with the 2013 guidance;

Assessment of the resident’s history and current status on admission (who was the resident, likes dislikes, etc.);

Behavioral monitoring being accurate and only one medication with targeted behaviors per monitoring sheet;

Training of staff regarding all aspects of the residents including dementia (proof of training required), targeted behaviors of ordered medications as well as interventions, and any safety issues, their roles in caregiving; be sure staff can articulate the facility philosophy on Dementia Care;

Safety of residents with dementia (water temperatures, environment, products unsafe for consumption (shampoo, alcohol gel or wipes, toothpaste, etc.);

Activities that stimulate the dementia resident;

Care planning individualized for the dementia resident, including medications, the diagnosis and or symptom they are intended to treat, plan for monitoring of side effects and gradual dose reductions;

Participation of CNA’s in Care Planning meetings;

Documentation of physicians intentions related to the use of antipsychotic medications (surveyors have contacted prescribing physicians to question them), if the Consultant Pharmacist or DON send communication to the physician recommending a dose reduction it is not deemed adequate for the physician to simply check a yes or no, the physician is expected to provide a written explanation regarding his or her plan for reduction or a response as to why a reduction is not appropriate;

Resident and Family council;

QAPI process related to reduction of psychotropic medications and involvement of the Medical Director;

Surveyor Checklist:

Click Here to download the surveyor checklist in .pdf format

Recommended reading:

CMS S & C Letter 13-35 – pdf format

CMS SC Letter 11-35 – pdf format

It is obvious that in order to be successful in these Focus Dementia Surveys, nursing facilities will have to adopt a person centered philosophy, fully embracing culture change. Beginning October 1^st, 2015, Texas surveyors will begin using this Dementia focused viewpoint during all annual surveys.