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Unbridled Spirit

Issue: # 09-2012       

                 September 2012

Welcome to the Office of Inspector General, Division of Health Care's 
September 2012 edition of the Long Term Care Provider Newsletter.  This newsletter is a valuable vehicle to update you on current events affecting Long Term Care.  

Please feel free to share this newsletter with anyone you think would benefit.  To continue receiving this newsletter, be sure to join our mailing list by clicking the link to the left of this article.  We look forward to serving you through this communication vehicle.


CMS Medicare News 

Recent Survey and Certification Letters


Below you'll find links to survey and certification letters issued by the Centers for Medicare and Medicaid Services (CMS) pertaining to Long Term Care facilities.  Please take a look and determine how these may impact your facility.
The following S&C memos were distributed this month:
To view previous S&C Memos click the link ==>  Survey & Certification Memos
Change is Good!!
Is It Time for Culture Change?
The buzz word in the industry is "culture change".  What is culture change?  It is synonymous with "resident-directed care", "person-centered care", and "individualized care".  It is determining each resident's preferences and identifying each resident's customary daily routine, in order to provide individualized care to the resident to enhance the resident's quality of life.  The Centers for Medicare and Medicaid Services (CMS) encourage facilities to review and revise their policy and procedures to promote culture change, and ensure resident choice.
Examples of changes to promote culture change include:  Click Here to Read More
Below are websites that offer good resources towards managing culture change:
It's Raining, It's Pouring
Are Your Sprinklers Working?
It's a good time for a reminder regarding the Centers for Medicare & Medicaid Services (CMS) requirement for mandatory sprinkler installation.  RainAll Skilled Nursing Facilities and Nursing Facilities must be equipped with a supervised automatic sprinkler system by August 23, 2013.  The sprinkler system must be installed in accordance with the 1999 edition of the National Fire Protection Association's (NFPA) "Standard for the Installation of Sprinkler Systems" (NFPA 13).  All CMS certified facilities need to evaluate sprinkler statuses as referenced in S&C - 09-04.
Dementia Care
CMS Partnership to Improve Dementia Care
in Nursing Homes
In 2012, Centers for Medicare & Medicaid Services (CMS) launched the Partnership to Improve Dementia Care in Nursing Homes to promote comprehensive dementia care and therapeutic interventions for nursing home residents with dementia-related behaviors.  The goals of the initiative include focus on person-centered care and the reduction of unnecessary antipsychotic medication use in nursing homes and   eventually other care settings as well.
CMS is using several approaches to successfully implement this initiative.  CMS is developing and conducting trainings for nursing home providers, surveyors, and consumers.  CMS is conducting research, raising public awareness, using regulatory oversight, and public reporting to increase transparency. 
Additionally, CMS has partnered with organizations to encourage communication among the national organizations and their members.  Below are some organizations with resources regarding dementia care:


The Affordable Care Act, Section 6121 requires CMS to ensure nurse aides receive regular training on how to care for residents with dementia and on preventing abuse.  CMS created the training program, "Hand in Hand: A Training Series for Nursing Homes," on Person-Centered Care of Persons with Dementia and Prevention of Abuse.   To find out more view the Hand in Hand Tool Kit


Identifying Vulnerable Older Adults and Legal Options for Increasing Their Protection During All-Hazards Emergencies. 

We cannot accurately predict which groups of people will be most affected by future emergencies. However, recent events have shown that some Tossed About  characteristics of older adults put them at greater risk of illness and death during many types of emergencies. For example, older adults may have impaired mobility, diminished sensory awareness, multiple chronic health conditions, and social and economic limitations-all of which can impair their ability to prepare for, respond to, and adapt during emergencies.


An emergency or disaster also can disrupt vital support systems that older adults rely on. For many older adults, independent living is made possible only with help from friends, family, and in-home services that provide meals, home-based health care, and help with the activities of daily living.  Events such as Hurricane Katrina in 2005 and the earthquake and tsunami in Japan in 2011 showed how vulnerable older adults can be during emergencies. Unfortunately, research conducted for this guide found three major limitations to our ability to plan for and protect older adults:

* Many different strategies are being used to identify vulnerable older adults across the country, but none of these strategies have been evaluated.
* No consensus exists on the best way to identify and protect older adults.
* Gaps exist in legal mandates to protect older adults.

This guide is intended to help close many of the gaps in emergency planning and preparedness for vulnerable older adults. In particular, it aims to give public health officials, the Aging Services Network, emergency management personnel, and essential partners from other sectors and at all jurisdictional levels (community, regional, tribal, and state) the critical information, strategies, and resources they need to improve the planning for and protection of vulnerable, community-dwelling older adults during all types of emergencies (often
referred to as all-hazards emergencies).  Click Here to Read More.....

Let Us Clarify...

ClarifyOIG Provides Clarification to Provider Training Held on August 28th


The training provided on Tuesday, August 28th by Sue Ann Guildermann focused on the reduction of restraints and alarms as part of a fall prevention program.  Alarms, low beds and mats on the floor are not automatically considered physical restraints.  Facilities should review the use of these devices for each resident prior to deciding to discontinue these interventions. When OIG surveyors are investigating a fall, the survey process is unchanged.  If a device is being implemented, the surveyor would conduct a review to determine if the use of a device was assessed and care planned.  The OIG encourages facilities to review the use of devices and to incorporate the evaluation of these devices in their fall prevention program. 


The Office of Inspector General is Kentucky's regulatory agency for licensing all health care, day care and long-term care facilities and child adoption/child-placing agencies in the commonwealth. 

If you would like more information, visit our website at
If you have an idea for a future article, e-mail Terri Cook at
Unbridled Spirit