Nursing Home Regulatory Fiasco – PART I
by Tom aka Rusty
NURSING HOME REGULATORY FIASCO – PART I
Nursing homes are subject to a two part interactive regulatory system (plus several others) used to calculate certain reimbursement levels.
The Minimum Data Set 2.0 (MDS) is a clinical reporting system that is supposed to improve care by having nurses do more paperwork (more on this in Part II).
Resource Utilization Groups III categorizes residents into 44 acuity groups. The two systems interact to calculate facility acuity levels (very oversimplified explanation).
On October 1, 2010 MDS 3.0 and RUGs IV are supposed to be put into place. Problem is, MDS 3.0 is ready for roll out, but RUGs IV is not. If no solution is found soon, the feds will have to rig some sort of half-assed patch to keep the system working. RUGs IV should be done in another year.
The feds now face writing tens of thousands of pages of regulations to implement Obamacare, yet cannot finish work started with several years of lead time. Ugly, very ugly.
Rdan: The major question is: Does Rusty still have any hair left?
I get it now. We have to raise the retirement age so people can make enough money to afford the nursing home they go to when they can’t work any more. It’s a win win for the economy.
And it’s a bit of a tragedy that those people have no one from the outside who cares enough about them to keep the nursing homes honest. So it has to managed by a fearsome government bureaucracy. Hey, it’s a win win win.
Fearsome is ok as long as it is competent. Lack of competence is the problem.
Despite my advanced age, my hair is thick and black. Due to genetics, not clean living.
competence is a rather more scarce commodity than most people suppose. it’s why bureaucracies have a bad name.
and no. that does not mean unfettered free enterprise is the solution.
Nursing homes, the pariahs of the helath care system. And it has been that way for decades. Endless exposes in the press followed by endless efforts to “regulate” the care given. They are primarily funded through Medicaid and it is a constant tug of war between the systems’ ownerships and the government regulators and fees setters. It seems unlikely that the attentiveness of family can improve the situation. How does one see through the veneer of adequacy that can be constructured to cover up a dismal setting. A short walk through some of the better regarded homes in the Nyc area is depressing. We all know that it is the last choice for our aged loved ones, but then it becomes essential when health starts to fail in a more serious manner. That is especially true when the failure is due to dementia/Alzheimers.
The individual can’t even report for themself what’s going on.
I worked for more than twenty years in a similar care setting, residential and habilitation for the developmentally disabled. Same funding mechanism. Similar massive book of regulations. Similar financial constraints. No book of regulations nor system of over sight could make the system work very well. Adequate performance was an unspoken goal. Don’t let anyone die, if possible, and try to provide a reasonable living and “training” setting. The big book of regualtions only deliniated what had to be documented. Records were the be all and end all. The focus of every care review audit was the cleints’ records. If it was written down it was done. The result being, of couorse, that all focus was on good records regardless of what actually went on.
It’s a huge and seemingly insumountable problem, the provision of quality care for those who are either too old and infirm or too personally limited to look after themselves. Money!! Nothing that money can’t solve. But isn’t that true of every aspect of life?
Ah yes dirtly little secret about the US government #2 It does not have sufficient resources to write all the regulations that congress directs. Partly this is due to the convoluted process required to write them, but also because there are not sufficient regulation writers for the demand congress places on them
Dirtly little secret #3 An IT project runs twice as long and costs twices as much as projected because people don’t know what they want, so they keep changing, and all feel that to change the way they do business is not proper.
And Finally dirtly little secret #1 (related to #2) The Us does not have sufficient courts and US attorneys to prosecute all the crimes congress invents. So its prosecution by example, pick a sucker and make an example of them. The thought is others will be disuaded from doing the same thing. (Excuse the cynicism of this post)
But you see, with nursing home care these people are living longer and longer.
That’s why they can work longer and longer.
Considerable thing is that how to provide maximam comfort to our dear ones, and it is needed to improve the nursing home facilities, Thanx for this bringing to our attention.
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