Protect Nursing Home Nurse
Aide Training Requirements;
Protect Residents’ Right to High Quality Care
Certified
nurse aides provide most of the direct hands-on care to the nation’s 1.3
million nursing home residents. Aides’ central role in caregiving
means that the training that aides receive to become certified must be
adequate and appropriate to ensure that they are capable of providing high
quality of care and quality of life services to residents.
At
present, training can be provided by a variety of entities, including
vocational schools, unions, and nursing facilities themselves. If a nursing
facility wants to provide certification training using its own staff, it is
crucial that care practices in the facility meet or exceed federal
standards, so that new aides are taught good practices. Equally
important, a facility conducting a nurse aide training program must have
sufficient numbers of staff so that residents are not put at risk when a
facility shifts nurses from the floor to the classroom.
Unfortunately,
the nursing home industry is exploiting the current enthusiasm for
deregulation to weaken these essential safeguards.
What
federal law says about nurse aide training: Federal law allows
nursing facilities to conduct their own nurse aide training programs,
except under certain limited circumstances. These circumstances
include failure to have sufficient numbers of licensed nurses as otherwise
required and serious quality of care deficiencies that led to the imposition
of civil money penalties (CMPs) of (at present) at least $10,697.[1] By
law, a prohibition on a facility-conducted aide training program continues
for two years to assure that a facility demonstrates its ability to provide
good care to residents over a sustained period of time.
Federal
law allows states to waive the prohibition of a facility-conducted nurse
aide training program if the state determines that “there is no other such
program offered within a reasonable distance of the facility” and if the
facility assures that it provides “an adequate environment” for a program
conducted by a third party.[2] Federal law also allows the
Secretary to waive the disapproval of a facility-based training program if
the civil money penalty was not related to quality of care provided to
residents.[3]
If a
facility is prohibited from conducting its own training program, a program
may be provided in the facility, but it must be conducted by someone other
than facility staff.
Two
related bills, S. 2993[4] and H.R. 4468,[5] weaken current law by allowing
the Secretary to impose a shorter period for the prohibition of a
facility-conducted nurse aide training program and to lift the prohibition
before two years.
Few
facilities are barred from conducting nurse aide training programs: There are no
national data on the number of facilities that conduct their own nurse aide
training programs, have been prohibited from providing such a program, or
have received waivers of nurse staffing requirements. However, federal
enforcement data indicate that the combination of undercoded deficiencies
and limited penalties means that very few facilities ever face loss of
their aide training program, if they even offer one.
Two facts
about enforcement explain why bans on aide training programs are likely to
be rare. First, civil money penalties are generally imposed only when
a facility is cited with a deficiency that is classified as actual harm or
immediate jeopardy, classifications that are assigned to less than 4% of
all deficiencies nationwide.[6] Second, the default CMP is
now a per instance penalty, rather than a per day CMP. In Fiscal Year
2018, the average per instance CMP was $9,281.90, in Fiscal Year 2019,
$10,279.22,[7] both lower than the amount that
leads to loss of authority to conduct a nurse aide training program.
Consequently, even for the small number of facilities that are cited with
serious deficiencies, the federal government is unlikely to impose a
penalty that would lead to the facility’s loss of its ability to conduct a
nurse aide training program.
Facilities
barred from conducting a nurse aide training program provide extremely poor
care to residents: Two examples of facilities that had civil
money penalties imposed against them illustrate how appropriate, and
inappropriately rare, a ban on facility-conducted nurse aide training
programs actually is.
Bethlehem
Commons Care Center, a New York state nursing facility, was cited on April
20, 2017 with 12 deficiencies,[8] including physical
restraints, failure to develop a care plan to address a resident’s serious
pressure ulcer, infection control (surveyors observed that five of five
dressing changes were done incorrectly), and failure to maintain accurate
clinical records. Three of the 12 deficiencies reflected immediate
jeopardy (the most serious category of deficiencies) for the high
temperatures recorded in refrigerators, coolers, and freezers where food
and milk for residents were stored. The order for repair of the
freezer was dated March 6, 2017, six weeks before the survey. The
Centers for Medicare & Medicaid Services (CMS) imposed a per day civil
money penalty totaling $29,188. By operation of law, Bethlehem
Commons Care Center may not conduct a nurse aide training program.
In
contrast, Fresh River Healthcare is not barred from conducting a nurse aide
training program even though CMS cited the Connecticut nursing facility
with an actual harm quality of care deficiency in 2018. The
deficiency, accident hazards/supervision, was based on an incident
involving a resident in the secured unit who had a diagnosis of
schizophrenia, repeatedly demonstrated bizarre behavior and thought
patterns, hoarded items, manifested auditory hallucinations, wandered, and
had “a history of self-injurious behavior including a possible suicide
attempt in the past by ingesting bleach.”[9] The resident ingested hand
sanitizer that a nurse or someone else had left unattended in the unit and
was hospitalized as a result, suffering from “respiratory failure, severe
sepsis, and acute encephalopathy, attributable to ingesting hand
sanitizer.”[10] Fresh River Healthcare, if
it chooses, may conduct a nurse aide training program because the per
instance CMP was $10,000.[11]
Federal
law should not be changed: Nursing facilities providing extremely poor
care that harms and injures residents should not be training new aides in
how to provide care. Any changes that are made should strengthen the
standards for conducting a nurse training program, not further weaken them.
______________________
[1] 42 U.S.C.
§1395i-3(f)(2)(B)(iii)(1)(a)-(c).
[2]
42 U.S.C. §1395i-3(f)(2)(C)(i).
[3]
42 U.S.C. §1395i-3(f)(2)(D).
[4]
The “Ensuring Seniors’ Access to Quality Care Act” (Senators Warner (D-VA),
Scott (R-SC)), https://www.congress.gov/bill/116th-congress/senate-bill/2993/text.
[5]
The “Nursing Home Workforce Quality Act” (Congressman Evans (D-PA) and 11
cosponsors), https://www.congress.gov/bill/116th-congress/house-bill/4468/text.
[6]
CMS, Nursing Home Data
Compendium 2015 Edition, Figure 2.2.e, Percentage Distribution
of Scope and Severity of Health Deficiencies: United States, 2014 (showing
0.9% of deficiencies cited as immediate jeopardy; 2.3% cited as actual harm
(total, 3.2% as immediate jeopardy or actual harm), https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/Downloads/nursinghomedatacompendium_508-2015.pdf
(most recent federal data).
[7]
CMS, QCOR, CMS Civil Money
Penalty (CMP) Report, Fiscal Year 2019, site accessed Dec. 20,
2019.
[8]
https://www.medicare.gov/nursinghomecompare/InspectionReportDetail.html?ID=335735&INSPTYPE=STD&SURVEYDATE=04/20/2017.
[9]
https://www.medicare.gov/nursinghomecompare/InspectionReportDetail.html?ID=075359&SURVEYDATE=07/10/2018&INSPTYPE=CMPL&Inspn=HEALTH&profTab=
1&Distn=6663.0&state=CT&lat=0&lng=0&name=
FRESH%20RIVER%20HEALTHCARE. (survey report for July 10, 2018
complaint survey).
[10]
Fresh River Healthcare v.
CMS, Docket No. C-19-31, Decision No. CR5352, p. 5 (Jun. 19,
2019), https://www.hhs.gov/about/agencies/dab/decisions/alj-decisions/2019/alj-cr5352/index.html.
[11]
Administrative Law Judge Steven T. Kessel sustained the CMP. Fresh River Healthcare v. CMS,
Decision No. CR5352 (Jun. 19, 2019), https://www.hhs.
|
No comments:
Post a Comment