July 18, 2013
How Government Regulations Preclude the Senior Home Owner From Implementing Desirable Change
A Change of Culture
Historically, senior care facilities were run akin to a franchise business model. Standardization was thought to be the key to running an efficient, safe, and profitable enterprise. Patients weren’t deemed as people so much as they were deemed as a product. This is not to say that treatment was poor-although there are always specific instances of inadequate care-it just wasn’t individualized. Individualization has become the new standard of care in senior care facilities. The focus has shifted from a “macro” standards of care to a “micro” standard of care where senior care employees address the individual needs of every patient in order to make there twilight years as pleasant as possible. These changes include collaborative decision-making, a more home-like and welcoming environment, a focus on close relationships among residents and empowered staff, and efforts to improve quality of resident life as well as the quality of professional services. Culture change may be reflected in such practices as encouraging the regular presence of pets and children in the facility, incorporating residents and families into care-planning sessions, permitting the residents to voluntarily perform tasks such as maintaining plants, and providing the opportunity for restaurant-style dining and snack preparation.
How Regulations Present a Hurdle to a Positive Culture Change
There is widespread consensus that implementation of culture change has the potential to significantly improve the quality of residents’ lives. Nevertheless, several substantial impediments to a more universal and enthusiastic adoption of the person-centered paradigm persist. One of those barriers is provider apprehension about the present regulatory labyrinth that engulfs every facet of nursing home care. The pertinent regulatory web, with its heavy emphasis on risk aversion, is embodied in extensive federal Medicare/Medicaid Conditions of Participation (running roughly 70 pages), the complicated survey and certification process intended to measure providers’ compliance with those requirements (the relevant portion of the federal State Operations Manual exceeds 660 pages), and the separate licensure statutes, regulations, and guidelines of each state. Moreover, the civil law tort (personal injury) system, as enforced through the courts by the levying of monetary damages against defendants, is another form of regulation that may be used to penalize providers for deviation from then-standard practices.
How can senior care owners/operators attempting to adhere by this shift in culture change and subsequent treatment practice when government regulations present an impediment to every substantial change? The answer may lie where most answers do: in the balance. Lawmakers and senior care advocates need to devise a regulatory system that meets the needs of patients while simultaneously appeasing lawmakers. This is no doubt a daunting and challenging task, but if successful could certainly advance the standard of care in senior facilities.