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Moving to a nursing home is a life changing event. Last year the Centers for Medicare & Medicaid Services (CMS) issued new guidance for nursing home surveyors emphasizing the importance of resident quality of life and homelike environments. CMS is making clear through these regulations that residents should be afforded personal choice with respect to their care in a “de-institutionalized” setting.

One of the new guidelines provided by CMS includes determining during resident interviews and care plan meetings what time the resident awakens and goes to sleep and whether this is the resident’s preferred time. The facility should also honor the resident’s preferences regarding timing for bathing (morning, afternoon, evening and how many times a week) and also the method (shower, bath, in-bed bathing).

Another area addressed was decreasing the institutional character of the environment including the elimination of:

  • overhead paging and piped in music throughout the building
  • meal service in the dining room using trays
  • medication carts
  • the widespread and long term use of audible chair and bed alarms instead of their limited use for selected residents for diagnostic purposes
  • mass purchased furniture, drapes and bedspreads that all look alike throughout the building
  • large, centrally located nursing/care team stations.

The guidelines say that the “homelike environment” is not achieved simply through enhancements to the physical environment. It concerns striving for person-centered care that emphasizes individualization, relationships, and psycho social environment that welcomes each resident and makes him/her comfortable.

The guidelines now provide 24 hour access to visitors, regardless of familial status. Previously only immediate family families along with governmental officials were afforded 24 hour access.

We hope that these interpretive guidelines will help transform the environment of nursing homes into more comfortable, pleasurable places for elders to call home.