Nursing Homes Face Increased Documentation Requirements, but Changes are Positive for Residents

The L.A. Times reported on the increasing paperwork burden on nursing homes across the nation on March 6, 2011. According to author Michael Hiltzik, the nursing home application required by the federal government can span 38 pages. While this is a thorn in the side of many admissions directors, the application benefits residents in the long run by getting them involved in their own care. The Minimum Data Set required for nursing home residents now spans 38 pages.

It’s not just the initial application that is exceedingly lenghty–the same application must be filled out periodically during a resident’s stay, and at any discharge. That means whether the resident is being discharged home with family or discharged for an unexpected trip to the emergency room in the middle of the night. (And, yes, that means yet again upon re-admission.)

The application, termed the Minimum Data Set, has been required by the federal government for all nursing home admissions and residents since October 2010. Three of the 38 pages are dedicated to questions regarding bed sores, and the remaining pages revolve around the resident’s perceptions of pain, whether or not the resident can correctly identify what month we’re in, number sequences, and so on.

State nursing home inspection officials (agencies vary from state to state) use the data to gauge a nursing home’s performance and quality of care. Medicare uses it to set the rate of reimbursement for skilled nursing facilities, so there’s no way to avoid completing this paperwork without impacting the bottom line. Because some of the questions are open-ended and require discussion with residents, the entire process can span several hours, taking a significant chunk of time from admissions coordinators, nurses and other staff.

Robert A. Applebaum, an expert on long-term care at Miami University in Ohio, says nursing homes are moving away from their old minset of being the last segment in life, as many residents stay for only a short time before moving to a specialized care facility or returning home with their families. One of the key components of the new Minimum Data Set requires the staff member to directly ask the resident about future plans and whether they intend to stay in the nursing home on a short or long-term basis.

The revamped Minimum Data Set is the first step by the federal government to take regulatory action to draw residents in as a more active player in the creation of their care plan and day-to-day activities.

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