Re: CMS-2131-P- Medicare & Medicaid Programs; Requirements for Paid Feeding Assistants in Long Term Care Facilities (67 Federal Register 15149), March 29, 2002.
Liberty Place, Suite 700
325 Seventh Street, NW
Washington, DC 20004-2802
(202) 638-1100 Phone
Friday, May 24th 2002
Thomas A. Scully
Centers for Medicare & Medicaid Services
200 Independence Avenue, S.W., Room 443-G
Washington, DC 20201
Dear Mr. Scully:
On behalf of our nearly 5,000 hospital, health system and other health care provider members, the American Hospital Association (AHA) welcomes the opportunity to respond to the Centers for Medicare & Medicaid Services' (CMS) proposed rule permitting long-term care facilities to use paid nutrition assistants to supplement the services of certified nurse aides (CNAs). The AHA represents approximately 2,000 hospital-based or affiliated skilled nursing facilities (SNFs) that would be affected by this proposal. Consistent with our efforts to achieve sensible regulatory reform, the AHA is pleased to strongly support the proposed rule and urges its finalization as soon as possible. This regulation will enhance the quality of care, while providing important flexibility to nursing facilities.
The proposed rule applies both to individuals paid solely to help residents eat and drink and to non-nursing staff employed in the facility, as long as they receive specialized training. It sets out minimum training elements for nutrition assistants, including communication and interpersonal skills; appropriate responses to resident behavior; safety and emergency procedures; infection control; resident rights; and recognition of changes in resident behavior that are inconsistent with normal behavior and should be reported to the supervisor. Registered nurses (RNs) would screen out residents whose needs are too complex for them to be assisted by non-nursing staff.
The proposal clarifies that nutrition assistants may not be counted toward minimum staffing requirements, and it requires facilities to maintain a record of paid assistants. Residents would have to be monitored frequently, even daily in some cases, to make sure that they are still candidates for assistance by non-nursing staff. Nutrition assistants must work under the direct supervision of an RN or Licensed Practical Nurse (LPN), and the nursing facility would be required to report any instances of abuse, neglect or misappropriation of resident property by a nutrition assistant. The proposed rule gives states discretion to permit these programs but does not mandate them.
AHA believes that by allowing nursing facilities to maximize the efficiency of their staff, this regulation would enhance the quality of life for nursing home residents by increasing the amount of individual attention they are able to receive from the staff. The use of specially-trained non-nursing staff to assist residents who may only need a little help with eating and drinking would enable nurses and certified nursing assistants to spend more time with residents whose care needs are more complex. In states where this kind of assistance has been permitted in the past, outcomes for residents have been positive, with reduced incidence of tube feeding, weight loss and urinary tract infections, and better maintenance of skin quality.
In addition to part-time workers, in nursing homes there are many employees who are neither CNAs nor licensed health professionals. Yet they have frequent and regular contact with residents. Training some of these individuals to assist low-risk residents with eating and drinking would enhance the quality of life for nursing home residents by increasing the amount of individual attention they are able to receive from the staff. In states where this kind of assistance has been permitted, outcomes for residents have been positive, with reduced incidence of tube feeding, weight loss and urinary tract infections, and good maintenance of skin quality.
Nutrition and hydration are basic human needs that have to be met. By enabling facilities to make better use of their staff, this regulation would help them fulfill this vital responsibility. Even in facilities that are highly staffed, nutrition assistants would serve an important function at mealtimes when the nursing staff's workload is especially heavy. The use of specially trained non-nursing staff to assist residents who may only need a little help with eating and drinking would enable nurses and CNAs to spend more time with residents whose care needs are more complex. Some residents merely need someone to sit with them and remind them to continue eating, and this role would be very suitable for a trained nutrition assistant.
The AHA fully agrees with the training safeguards specified in the proposal; the final regulation must ensure that the use of nutrition assistants will raise and not lower the quality of care in nursing facilities. Even with the specified training, registered nurses will need to continuously monitor and screen out residents whose needs are too complex for assistance by non-nursing staff.
Thank you for consideration of these comments. If you have any questions about these comments, please feel free to contact Brian Ellsworth, Senior Associate Director, Policy at (202) 626-2320.
Executive Vice President