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Florida Nursing Homes


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									A Message of Change

Agency for Health Care

  2001 Legislation Affecting
 Florida Nursing Homes and
   Assisted Living Facilities
Senate Bill 1202 - Initiatives

     • Quality Enhancements

     • Enhanced Enforcement

     • Tort Reform

     • Signed May 15, 2001
                                   SB 1202
                             Implementation Status

                                            Implementation Date
                Initiative                   (GAA/Legislation)               Status
Nursing Home Risk Management and                  5/16/01         Complete
Internal Quality Assurance Program
Nursing Home and Assisted Living                  5/16/01         Complete
Facility Adverse Incident Reporting
Nursing Home 6 Month Survey Cycles                5/16/01         Complete
Quality of Care Monitor Visits to Nursing         5/16/01         Complete
Homes and Assisted Living Facilities
Bed Vacancy Report                                5/16/01         Complete
Monthly Liability Claim Report                    5/16/01         Complete
Surveyor Guidelines for SB 1202                   7/17/01         Complete
Increased Staffing                                 1/1/02         On-going
Long Term Care Reimbursement Plan                  1/1/02         On-going

Nursing Home and Assisted Living                   1/1/02         On-going
Facility Liability Insurance
Adverse Incident Statistics
            As of 8/24/01

    • Total 2675 adverse incidents

    • 1975 (74%) nursing homes

    • 700 (26%) assisted living facilities

    • 21 investigated
 Increased Monitoring
SB 1202 pages 42 & 115
   (sections 18 & 46)
  Nursing Homes        Assisted Living
  • Quality of Care      Facilities
    Monitors           • Registered Nurse
  • Quarterly Visits     Monitors
  • Focus on Risk      • Extended
    Management           Congregate Care
  • 209 Quarterly        Quarterly Visits
    Visits Conducted   • Limited Nursing
    to Date              Services Semi-
                         annual Visits
                       • 107 Visits
                         Conducted to Date
  Liability Insurance
SB 1202 pages 52 & 140 (sections 22 & 66)

   Nursing Homes              Assisted Living
   • Liability                  Facilities
     Insurance                • Existing
     Required                   Requirement
   • AHCA Action                Remains
     Delayed Until            • AHCA Action
     January 1, 2002            Delayed Until
                                January 1, 2002
Medicaid Nursing Home
  • AHCA directed to modify the nursing
    home reimbursement plan to split
    patient care into direct and indirect
  • Eliminate an increase in the Medicaid
    nursing home reimbursement rate due
    to a change of ownership to an
    unrelated party - Effective September 1,
  • AHCA annual report of direct and
    indirect care costs and staff salaries
    each July 1st
  • AHCA to request federal waiver to use
    Medicaid per diem to fund risk retention
    group for self-insurance
Additional Provisions in SB 1202

      • Medicaid Up or Out
      • Study of Electronic Monitoring
        Devices in Nursing Homes
      • Moratorium on CON for Nursing
        Home Beds
      • SB 1202 Applies Only to Nursing
        Homes and Assisted Living Facilities
        Licensed Under Chapter 400
Medicaid Up or Out
• Improve the quality of care for
  Medicaid residents in poor performing
  nursing homes and assisted living
• Develop a pilot to demonstrate the
  affect of assigning skilled and trained
  medical personnel to ensure the
  quality of care, safety, and continuity of
  care for long-term Medicaid recipients
  in the consistently poor performing
Medicaid Up or Out Strategy
    • Maximize the capacity of Medicare
      HMOs to manage the medical and
      supportive care needs of long term

    • Contract for programs which would
      assign skilled geriatric nurses to the
      poor performing facilities
Certificate of Need Moratorium
      Nursing Home Beds

     • Five Year Moratorium Until
       July 1, 2006
     • Excludes Sheltered Beds
     • Low Nursing Home Bed Occupancy
     • Intended to Promote Development
       of Home and Community-Based
Electronic Monitoring Devices

     • Joint Project Between AHCA and the
       Attorney General’s Office
     • Initial Research Completed
     • Public Meeting Scheduled in October
     • Report Due January, 2002
Additional 2001 Legislation
    • Immunization Requirements HB
      -Mailed to Nursing Homes 8/24/01
    • Additional Funding for the Teaching
       Nursing Home
       - Geri U Web Site
       - Dementia Training Modules
     • Center on Nursing
    • DOEA Promulgating ALF Rules and
      Nursing Home Alzheimer’s Training
    • AHCA Nursing Home Rule Revisions
      Workshop August 17, 2001
Update on Legislation

 • Medical Director Requirements
   59A-4.1075, Effective August 2,
 • Nursing Home Gold Seal Rule 59A-
   4.200, Effective August 17, 2001
 • Nursing Home Guide
   Beta Testing for Internet
 • Consumer Satisfaction Survey
Medical Director Criteria
   • Designate One Physician to Serve as
     Medical Director
   • Must Have Hospital Privileges or be
     Certified or Credentialed
   • Principle Office within 60 Miles
     (Exceptions for Rural Locations)
   • Maximum of Ten Facilities
   • Visit Facility at least Once a Month
   • Review all Policies, Incident Reports,
     and Grievance Logs for Clinical Issues
Gold Seal Award Criteria

  Nursing Home Must Be Licensed
   For 30 Months

  Quality of Care Standards
  • Consider Past 30 Months
  • Top 25% In Quality of Care Rank
  • No Conditional Licenses
  • No Class I or II Deficiencies
Gold Seal Award Criteria

     Financial Standards

     • Free of Bankruptcy Proceedings
       For Past 30 Months

     • Meet Two of Three Financial
       Thresholds Over 30 Months or All
       Three Thresholds For Past Six-
     - Positive Current Ratio of At Least One
     - Positive Tangible Net Worth
     - Time Interest Earned Ratio of At Least
Gold Seal Award Criteria

    Staff Stability

    • Turnover Rate of Not More Than
    • A Stability Rate of At Least 50%
    • Evidence of Efforts To Maintain
      Stable Workforce
Gold Seal Award Criteria

  • Outstanding Ombudsman Complaint
  • Evidence of Family And Community
  • Targeted In-Service Training
Gold Seal Review

• Governor’s Panel on Excellence in
  Long Term Care will Review
  Applications at Meetings (Locations
• Opportunity to Present Before the
  Governor’s Panel on Excellence in
  Long Term Care
• Facility Site Visit by Panel Members
• Recommendations to Governor
Gold Seal Application
Nursing Home Guide

AHCA Web Site: www.fdhc.state.fl.us
 See Nursing Home Guide Button

Elizabeth Dudek, Deputy Secretary
Managed Care and Health Quality
(850) 487-2528
Journey Through Chapter 400

        2001 Senate Bill 1202
 Regulatory Impact on Florida Nursing
Relevant Materials

• Bill on Page 15 of Handouts
• New 2001 Statutes Available:
• ASPEN State Regulation Set for
  Nursing Home Licensure
  - Survey Guidance
  - Available AHCA (850) 488-5861
  Public Records
• All Records at AHCA are Public
• Unless Specifically Exempt from Public
  Review (Adverse Incidents)
  - Each Letter Received
  - Each Survey Report
  - Each Application Submitted
• Hundreds of Requests Each Month
• Accuracy of Information Submitted is
  Critical, Including Resident Census
 Quality Measures

• Nursing Home        • Discharge &
  Risk Management       Transfer
• Assisted Living     • Liability Insurance
  Adverse Incident    • Care Plan Signed
  Reporting             by DON and
• Increased Monitor     Resident
  Visits by the       • Physician Referral
  Agency                for Signs of
• Nursing Home          Dementia or
  Staffing              Cognitive
  Requirements          Impairment
• Staff Training      • Daily ADL Charting
Risk Management
SB 1202 pages 53
   (section 24)

Nursing Homes
• Risk Manager
• Program & Committee
• Monthly Meetings
• Adverse Incident Investigation &
AHCA Risk Management Forms

     • 1-Day Adverse Incident Report

     • 15-Day Adverse Incident Report

     • Monthly Report of Liability Claim
Nursing Home Risk Manager

    Question – Must a nursing home risk manager be
      licensed or credentialed?

    Answer - Section 400.147(1)(a) does not require
      that the risk manager have particular
      credentials, only that the facility have a risk
      manager designated who is responsible for the
      implementation and oversight of the facility’s
      risk management and quality assurance
Adverse Incident Reports
   SB 1202 page 55
     (sections 24)

   Nursing Home
   • Initial Report
   • 3 Days to Risk Manager
   • 1 Day from Risk Manager to Agency
   • Complete Report 15 Days to Agency
Adverse Incidents Defined
  Facility Responsibility
       Nursing Homes

       An event over which facility
       personnel could exercise control
       and which is associated in whole
       or in part with the facility's
       intervention, rather than the
       condition for which such
       intervention occurred, and which
       results in one of the following:
Adverse Incidents Defined
  Facility Responsibility
    •   Death
    •   Brain or spinal damage
    •   Permanent disfigurement
    •   Fracture or dislocation of bones or joints
    •   A limitation of neurological, physical, or sensory
    •   Any condition that required medical attention to
        which the resident has not given his or her consent,
        including failure to honor advanced directives
    •   Any condition that required the transfer of the
        resident, within or outside the facility, to a unit
        providing a more acute level of care due to the
        adverse incident, rather than the resident's condition
        prior to the adverse incident
Adverse Incidents Defined

   Facility Responsibility is Not Considered

   • Abuse, neglect, or exploitation as
     defined in s.415.102
   • Abuse, neglect and harm as defined in
     s. 39.01
   • Resident elopement
   • An event that is reported to law
Resident Elopement

Question: How is “elopement” defined for
  the purposes of adverse incident

Answer: Elopement is when a resident
  leaves the facility without following
  facility policy and procedure.
Adverse Incident Reporting
     Question – If, prior to the required report date, facility
       staff determine that an incident does not meet the
       definition of an adverse incident as specified in
       statute, is a report to the Agency still required?

     Answer – Only those incidents that meet the
       definition of an Adverse Incident must be reported
       to the Agency. If the facility is able to determine
       that the incident does not meet the definition,
       prior to the required report date, then a report is
       not required. However, if the facility has not yet
       determined if the incident meets the definition the
       incident must be reported on the 1-Day report.
       After the facility investigation is complete and if it
       is determined that the incident does not meet the
       definition of an adverse incident, then the facility
       staff may report on the 15-Day report that the
       incident was determined not to be an adverse
Confidential Nursing Home Initial
Adverse Incident Report – 1 Day
Confidential Nursing Home Complete
 Adverse Incident Report – 15 Day
AHCA Adverse Incident Review
       1- Day Reports are reviewed by a clinician
          to determine necessary AHCA
          involvement. Possible outcomes:
       • Decision to wait for 15 – Day Report
          (facility investigation)
       • For situations that rise to level of threat
          to resident health and safety:
          *On-site review by Field Office
          *Review of report for possible
          practitioner involvement
       • Additional information requested
AHCA Adverse Incident Review

      15- Day Reports are reviewed by a
        clinician to determine necessary
        AHCA involvement. Possible
      • On-site review by surveyors for
        situations that rise to level of threat
        to resident health and safety
      • Review of report for possible
        practitioner involvement
      • No action necessary
      • Reports will be used for surveyor off-
        site preparation
Adverse Incident Reports

   When completing a report, providing
    answers to basic questions allows
    AHCA reviewers to determine
    appropriate action.

   Basic Questions:
     Who, What, Where, When, Why
     AHCA Annual
Adverse Incident Reports
    AHCA Annual Reports to Legislature
    • Total number of adverse incidents
      by county
    • Categories of incidents and type of
      staff involved
    • Types and number of injuries by
    • Types of liability claims filed based
      on adverse incidents
    • Disciplinary action taken against
  Nursing Home Monthly
Liability Claim Information
Nursing Home Monthly Liability Claim
    Information Form Completion

         • Include the Facility Name on Each
         • Do Not Use the Monthly Liability
           Claim Information Form to Report
           Adverse Incidents
      Nursing Home Staffing
            SB 1202 page 72 (section 30)

 Hours of Direct Care per Resident per Day

      Certified Nursing               Licensed Nurses
        Assistants                    • Effective 1/1/02
      • 1/1/02 - 2.3 Hours            • 1.0 Hours
        Never Below 1:20              • Never Below 1:40
      • 1/1/03 - 2.6 Hours
      • 1/1/04 - 2.9 Hours

Never Below 1:20 CNA and 1:40 Licensed Nurse is
        an Alternative to Per Shift Ratios
Staff Counted Toward Ratio
      SB 1202 page 72 (section 30)
     • Nursing Assistants (awaiting
       certification – see definition 400.211)
       may be counted toward CNA ratio if
       providing nursing assistance services to
       residents on a full-time basis
     • 4-Month Window - in an approved (by
       Dept of Education) training program or
       awaiting reciprocity
     • CNAs and Licensed Nurses – time spent
       providing direct care to residents
     • Nurse Managers – can count time spent
       providing direct care if part of their
 Report Staffing Information
SB 1202 page 50 (section 22)
     • 400.141(15) Requires minimum of semi-
       annual reporting of staff ratios,
       turnover and stability to AHCA
     • Gold Seal criteria
     • Ratio in categories specified in
       400.23(3)(a) and rules – average for the
       most recent calendar quarter
     • Turnover for most recent 12-month
     • Staff stability – employees employed
       for more than 12 months
Report Staffing Information

    Question - When will providers have to
      begin submitting staff information to
      the Agency? Will the format for
      reporting be specified by the Agency?

    Answer – The Agency will request the first
      report in October 2001 for the period
      ending September 30, 2001. The report
      format will be provided by the Agency.
Moratorium for Insufficient Staff
         SB 1202 page 51 (section 22)

      • Self-Imposed Moratorium
      • No New Admissions if Fail to Meet
        Staffing Minimums for 2 Consecutive
      • Moratorium Stands Until Staffing
        Minimums are Achieved for 6
        Consecutive Days
      • Class II Deficiency for Failure to Comply
    Alzheimer’s Training &
Information for Nursing Homes
       SB 1202 page 62 (section 26)

     • Alzheimer’s Information Provided to
       All Staff

     • For Staff Hired After July 1, 2001:
        – 1- Hour Training for Direct Contact
        – 3- Hours Training for Direct Care
Alzheimer’s Training
   Direct Contact
  Question - For the purpose of the required
    1-hour training, how is "direct contact"
    defined? Would this definition include
    housekeeping and dietary personnel?

  Answer – Guidance to surveyors defines
    direct contact as person to person
    contact whether the contact be
    physical, verbal, or within the
    resident’s surroundings. Staff meeting
    this definition include but are not
    limited to nursing staff, dietary staff,
    activity staff, social service staff,
    housekeeping staff and maintenance
Alzheimer’s Training
    Direct Care

Question - For the purposes of the
  required 3-hour training, how is "direct
  care" defined? Would this definition
  include only nursing staff or therapists
  and others?

Answer – Direct care would include
  providing personal or health care
  services to residents.
Efforts to Develop Training

    • Department of Elder Affairs
      Final Criteria Not Yet Approved

    • Teaching Nursing Home

    • Alzheimer's Resource Center
     Alzheimer’s Training
Affected Staff / CNA Inservice

     Question - Are all existing direct care staff required to
       have 3 hours of Alzheimer’s training by July 1, 2002
       or only those hired after July 1, 2001?
     Answer - Only those hired after July 1, 2001. However,
       all staff are required to have the skills and education
       to provide the necessary care and services to

     Question - Can the Alzheimer’s training requirement
       count toward the 18 hours of CNA training required
     Answer – Yes.
Certified Nursing Assistants
   SB 1202 pages 68 &124 (sections 29 & 50)

           Nursing Homes CNA In-service
           • Requires 18 Hours of In-service
           • In-service Must Address Areas of
             Weakness As Determined by CNA
             Performance Review

           Certification of All CNAs 464.203
           • Requires Work in a 24 Month Period
             to Maintain Certification
           • Requires 18 Hours of In-service Each
             Calendar Year
Discharge & Transfer
   SB 1202 pages 36 (sections 13)

 Nursing Homes

 • AHCA Notice only Required if Facility
 • Notice Not Required if Initiated by
   Resident or Resident’s Physician
 • Consistent with Federal Notice
Revised Discharge/Transfer Forms
       English & Spanish
   Nursing Home
Discharge & Transfer
 Question – If the resident’s physician signs for the
   resident’s discharge is the AHCA Discharge
   and Transfer Notice required?
 Answer – 400.0255 requires the notice only for
   discharge initiated by the facility, not the
   resident or resident’s physician.

 Question – Does a Baker Act transfer require use
   of the AHCA Discharge and Transfer Notice?
 Answer – 400.0255 requires the notice only for
   discharge initiated by the facility, not the
   resident or resident’s physician.
Nursing Home Care Plan Definition
          SB 1202 page 14 (section 2)

       • Director of Nursing
       • Resident, Resident’s Designee or
         Resident’s Legal Representative
 Nursing Home Care Plan
DON Signature Delegation

Question - Can anyone else sign care
  plans in case of DON incapacity or

Answer – Guidance to Surveyors (N0076)
  details delegation of the DON signature
  to the Assistant DON in accordance
  with 59A-4.108(1) or to another nurse
  (registered) through formal delegation
  of institutional responsibilities
  demonstrates compliance. Such
  delegation should be documented and
  remain on file.
Nursing Home Care Plan
    DON Signature

Question – How often must the Director of Nursing (DON)
  sign the care plan?
Answer – The care plan must be signed by the DON each
  time it is completed, i.e. quarterly or when a
  significant change has occurred.

Question - Where does the DON sign the care plan?
Answer - The law does not specify where the DON should
  sign on the actual care plan. Each facility should
  develop a policy and procedure on the signature

Question – By what date must the DON must sign the
  care plan?
Answer – Guidance to Surveyors (N0076) indicates
  signature within 7 days of the comprehensive
  assessment as the care plans must be completed
  within 7 days.
Nursing Home Care Plan
  Resident Signature

  Question – What is the facility’s responsibility if
    the resident or resident representative will not
    sign the care plan?
  Answer – The facility staff should document and
    retain on file, efforts to obtain the resident
Referral for Evaluation of Dementia or Cognitive
             SB 1202 pages 51 (sections 22)

           Nursing Homes
           Question - When a facility notifies a physician that a
             resident exhibits signs of dementia or cognitive
             impairment, what is the facility responsibility after
             that notification?
           Answer - Facilities already have the obligation to
             implement appropriate interventions for a change
             in condition.
 Daily ADL Charting
SB 1202 page 50 (section 22) 400.141(21)

  • Resident medical record must include a daily
    chart of certified nursing assistant services.
  • The certified nursing assistant who is caring for
    the resident must complete this record by the
    end of his or her shift.
  • This record must indicate assistance with
    activities of daily living, assistance with eating,
    and assistance with drinking, and must record
    each offering of nutrition and hydration for
    those residents whose plan of care or
    assessment indicates a risk for malnutrition or
Enhanced Enforcement

  • Controlling Interest Information
  • Six-Month Survey Cycle for Nursing
  • Classification of Deficiencies
  • Fines for Violations
  • Enhanced Grounds for Agency Action
  • Required Nursing Home Revocation or
    Denial for Certain Violations
Nursing Home Controlling Interest
       SB 1202 page 12 (section 2)
AHCA May Deny Application Based on Adverse

          Defined as:              Disclosure Required at:
          • Applicant              • Initial Application
          • Licensee               • Change of Licensed
          • Management                Operator (CHOW)
            Company                • Renewal Application
          • Interest in Above:     • Change in
            - 5% or Greater           Management
              Ownership Interest      Company
            - Officer
            - Board of Directors   AHCA Form for
                                     Required Disclosure
               Board Members)
Controlling Interest Disclosure Form
Six-Month Survey Cycle
400.19 - SB 1202 page 65 (section 27)

   Requires 6-month survey cycle for 2
     years for a nursing home that has
   • been: for a Class I deficiency,
   • Cited for two or more Class II
     deficiencies arising from separate
     surveys or investigations within a 60-
     day period, OR
   • Three or more substantiated
     complaints within a 6 month period,
     each resulting in at least one Class I or
     II deficiency
   • Cited for last deficiency after 5/15/01
   • Seven facilities qualify as of 8/23/01
Six-Month Survey Fine

 • $6,000 fines for the 2-year period
   ($3,000 per extra survey)
 • Half ($3,000) paid at the completion
   of each survey
 • Agency may adjust the fine by
   consumer price index
 • Fine to be assessed by
   administrative complaint
  SB 1202 pages 77 (sections 30)

Nursing Homes

• Create Definition of “Scope” in State
• Create Class IV
• Align State Classification with Federal
  Assignment of Scope and Severity
Scope of Deficiencies
 400.23(8) SB 1202 page 76 (section 33)

   The scope shall be cited as isolated, patterned, or
     widespread. An isolated deficiency is a deficiency
     affecting one or a very limited number of residents,
     or involving one or a very limited number of staff, or
     a situation that occurred only occasionally or in a
     very limited number of locations. A patterned
     deficiency is a deficiency where more than a very
     limited number of residents are affected, or more
     than a very limited number of staff are involved, or
     the situation has occurred in several locations, or
     the same resident or residents have been affected by
     repeated occurrences of the same deficient practice
     but the effect of the deficient practice is not found to
     be pervasive throughout the facility. A widespread
     deficiency is a deficiency in which the problems
     causing the deficiency are pervasive in the facility or
     represent systemic failure that has affected or has
     the potential to affect a large portion of the facility's
 Class IV Deficiency
400.23(8)(d) SB 1202 page 79 (section 33)

  • A deficiency that the agency
    determines has the potential for
    causing no more than a minor
    negative impact on the resident.
  • If the Class IV deficiency is isolated,
    no plan of correction is required.
  • Correlates to A, B, or C level
         State & Federal Correlation

                 Class I                Class III
                 Isolated = J           Isolated = D
                 Pattern = K            Pattern = E
                 Widespread = L         Widespread = F

                 Class II               Class IV
                 Isolated = G           Isolated = A
                 Pattern = H            Pattern = B
                 Widespread = I         Widespread = C

Conditional License Issued for Citation of a Class I, Class II
                 or Uncorrected Class III
Enforcement Matrix
 SB 1202 pages 77 (sections 30)

Nursing Homes

• Required Fine Amounts
• Fines for Class II Regardless of
• Based on Classification and Scope of
• Effect for Surveys Completed 5/16/01
• Six-month Survey Fine
Nursing Home Fine Amounts
    400.23(8) - SB 1202 page 77
           (section 30)
     Class I                           * The fine amount
     Isolated (J) 10,000 / 20,000*        shall be doubled
     Pattern (K) 12,500 / 25,000*         for each
     Widespread (L) 15,000 / 30,000*      deficiency if the
                                          facility was
                                          previously cited
     Class II                             for one or more
     Isolated (G) 2,500 / 5,000*          class I or class II
     Pattern (H) 5,000 / 10,000*          deficiencies
     Widespread (I) 7,500 / 15,000*       during the last
                                          inspection or any
     Class III (uncorrected)              inspection or
     Isolated (D) 1,000 / 2,000*          complaint
     Pattern (E) 2,000 / 4,000*           investigation
                                          since the last
     Widespread (F) 3,000 / 6,000*        annual
Nursing Home Fines

• Uncorrected deficiencies are finable as
  independent deficiencies

• If a deficiency is uncorrected upon
  revisit as Class III, it is finable as an
  uncorrected Class III even if it was
  previously cited at a higher level (Class
  I or II)

• No fine is imposed for a Class IV
Fine Process
• Initial Notice by:
  Administrative Complaint
  (Deficiencies) or
  Intent to Impose Letter (Late
  Application Fines)
   - Elect to Pay or Challenge
   - 21 Days to Request Hearing
• Final Order Imposes Fine with 30
  Days to Pay
• If Not Paid, License May be
  Denied or Revoked
       Nursing Homes
Required Denial & Revocation
    400.121(3) SB 1202 page 45
           (section 20)

     • The Agency shall revoke or deny a nursing
       home license if the licensee or controlling
       interest operates a facility in the state that has:
     • Two moratoria for substandard quality of care
       in a 30 month period,
     • Conditional license for 180 consecutive days,
     • Two class I deficiencies on separate surveys in
       a 30 month period, OR
     • Two class I deficiencies on same survey for
       unrelated circumstances.
     • Licensee may present factors in mitigation of
       the action.
Enhanced Grounds for Action

    Nursing Home

    • Unpaid Fines
    • Alteration of Records
Additional Licensure Requirements
            in SB 1202
       Nursing Homes
       • Report Management Company
         Renewal and Change
       • Vacant Bed Reporting
       • Report Bankruptcy, Corporate
         Reorganization, or Transfer of
Additional Licensure Requirements
            in SB 1202

       • Resident Grievance Procedure
       • Post Watch List
       • Dining & Hospitality Attendant
Vacant Bed Reporting
Assistance with Eating
    Question – Who can assist a resident with eating?
    Answer – The Health Care Financing Administration
    (now CMS) defines assistance with eating, such as
    feeding a resident, as a nursing related service. The
    only staff who can provide nursing and nursing related
    services are nurses aides, licensed health
    professionals, registered dietitians or licensed
    dietitian/nutritionists and volunteers.

    Licensed health professionals are defined [42 CFR
    483.75(e)(1)] as a physician, physician assistant, nurse
    practitioner, physical therapist, speech therapist,
    occupational therapist, physical or occupational
    therapy assistant, registered professional nurse,
    license practical nurse or licensed or certified social

    Accompanying a resident during meal-time or queuing
    a resident to eat are not considered nursing related
    Feeding or hand-over-hand assistance are nursing
    related services.
      AHCA Duties
Nursing Home Survey Staff
      SB 1202 page 80 (section 32)

   • New Surveyors Spend Two Days in a
     Nursing Home
   • Joint Training for Surveyors and
   • 50% of Surveyor Training in Geriatric
   • Geriatric Experienced Physician or
     Nurse Participation in Informal Dispute
     Resolution for Substandard Quality of
Resources * Forms * Information

       AHCA Web Site: www.fdhc.state.fl.us

       Long-Term Care Unit (850) 488-5861
Presentation Materials

  This presentation was made during
  State-wide Provider
  Training September, 2001

  Material must be reviewed in conjunction
    with applicable statues and rules

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