What are the Federal Nursing Home Rules and Laws?

The United States Center for Medicare and Medicaid Services CMS upgraded the federal nursing home rules and regulations which they fund including additional changes highlighted in red.  For a complete copy of the CMS bulletin on federal nursing home rules this issue click here

According the to federal nursing home rules, the facility must ensure that –

(1) The resident environment remains as free from accident hazards as is possible; and

(2) Each resident receives adequate supervision and assistance devices to prevent accidents.

Intent: 42 CFR 483.25(h) (1) and (2) Accidents and Supervision

The intent of this requirement is to ensure the facility provides an environment that is free from accident hazards over which the facility has control and provides supervision and assistive devices to each resident to prevent avoidable accidents. This includes:

• Identifying hazard(s) and risk(s);
• Evaluating and analyzing hazard(s) and risk(s);
• Implementing interventions to reduce hazard(s) and risk(s); and
• Monitoring for effectiveness and modifying interventions when necessary.

DEFINITIONS

Definitions are provided to clarify terms related to providing supervision and other interventions to prevent accidents.

“Accident” refers to any unexpected or unintentional incident, which may result in injury or illness to a resident. This does not include adverse outcomes that are a direct consequence of treatment or care that is provided in accordance with current standards of practice (e.g., drug side effects or reaction).

“Avoidable Accident” means that an accident occurred because the facility failed to:

• Identify environmental hazards and individual resident risk of an accident, including the need for supervision; and/or
• Evaluate/analyze the hazards and risks; and/or
• Implement interventions, including adequate supervision, consistent with a resident’s needs, goals, plan of care, and current standards of practice in order to reduce the risk of an accident; and/or
• Monitor the effectiveness of the interventions and modify the interventions as necessary, in accordance with current standards of practice.

“Unavoidable Accident” means that an accident occurred despite facility efforts to:

• Identify environmental hazards and individual resident risk of an accident, including the need for supervision; and
• Evaluate/analyze the hazards and risks; and
• Implement interventions, including adequate supervision, consistent with the resident’s needs, goals, plan of care, and current standards of practice in order to reduce the risk of an accident; and
• Monitor the effectiveness of the interventions and modify the interventions as necessary, in accordance with current standards of practice.

“Assistance Device” or “Assistive Device” refers to any item (e.g., fixtures such as handrails, grab bars, and devices/equipment such as transfer lifts, canes, and wheelchairs, etc.) that is used by, or in the care of a resident to promote, supplement, or enhance the resident’s function and/or safety.

NOTE: The currently accepted nomenclature refers to “assistive devices.” Although the term “assistance devices” is used in the regulation, the Guidance provided in this document will refer to “assistive devices.”

• “Environment” refers to the resident environment. (See definition for “resident environment.”)
• “Fall” refers to unintentionally coming to rest on the ground, floor, or other lower level, but not as a result of an overwhelming external force (e.g., resident pushes another resident). An episode where a resident lost his/her balance and would have fallen, if not for staff intervention, is considered a fall. A fall without injury is still a fall. Unless there is evidence suggesting otherwise, when a resident is found on the floor, a fall is considered to have occurred.
• “Hazards” refer to elements of the resident environment that have the potential to cause injury or illness.
• “Hazards over which the facility has control” are those hazards in the resident environment where reasonable efforts by the facility could influence the risk for resulting injury or illness.
• “Free of accident hazards as is possible” refers to being free of accident hazards over which the facility has control.
• “Resident environment” includes the physical surroundings to which the resident has access (e.g., room, unit, common use areas, and facility grounds, etc.).
• “Risk” refers to any external factor or characteristic of an individual resident that influences the likelihood of an accident.
• “Supervision/Adequate Supervision” refers to an intervention and means of mitigating the risk of an accident. Facilities are obligated to provide adequate supervision to prevent accidents. Adequate supervision is defined by the type and frequency of supervision, based on the individual resident’s assessed needs and identified hazards in the resident environment. Adequate supervision may vary from resident to resident and from time to time for the same resident.

Contact a Minnesota Abuse Attorney

If you or a loved one has suffered an injury from neglect or abuse in a nursing home or other care facility that serves the elderly in Minnesota please contact our firm for a free consultation and information regarding the obligations of the facility and your rights as a resident or concerned family member. To contact Attorney Kenneth L. LaBore, directly please send an email to KLaBore@MNnursinghomeneglect.com or call Ken at 612-743-9048.

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