In September 2016, the Centers for Medicare and Medicaid Services (CMS) released the final Rules of Participation for nursing facilities, also known as the “Mega-Rule.” The rule aims to improve patient care and safety for close to 1.5 million residents in more than 15,000 long-term care facilities nationwide that participate in the Medicare and Medicaid programs. Compliance obligations for the rule will be implemented in three distinct phases, concluding in November 2019.

Phase 2 will take effect on November 28th 2017 and require significant changes from nursing homes. It is important that all staff members are attuned with the concept of person centered care and meaningful activities:

Ensure staff members have the right skill sets and competencies to provide person-centered care to residents. – CMS Objective Statement for Final Rule

According to Mary Chiles, RN, RAC-CT QCP, the President of Chiles Healthcare Consulting, a successful person-centered, non-chemical approach, means that it must be implemented and agreed to across departments in the community. “When this happens, there is an opportunity for the resident to be viewed and treated as an active partner in their daily life decisions.”

Rules of Participation Activity-Specific Components

F-TAG § 483.5 Definitions

Person Centered Care: for purposes of this subpart, person-centered care means to focus on the resident as the locus of control and support the resident in making their own choices and having control over their daily lives.

How to implement? Person centered care is not just adding an individual’s preferences to the care plan. That person needs to be given agency in their own life. We should even consider using the term “Person-Directed Care” instead.

F-TAG § 483.10 Self Determination

(Section B) The resident has the right to (1) choose activities, schedules (including sleeping and waking times), health care and provider of health care services consistent with his or her interests, assessments, plan of care and other applicable provisions of this part.

How to implement? Meaningful activities mean that a resident has the opportunity to participate in activities (not always recreational) and that participation makes them feel good, like they have accomplished something. Technology is an important component to meaningful activity.

(Section B) Resident has a right to participate in community activities

How to implement? Meaningful activities mean that we are utilizing activities that are responsive to preferences but also to a situation or an incident that has taken place. The professional also needs to understand how an intervention for one person can impact others in that same physical area. (For example using music without headphones can affect others).

F-TAG § 483.25 Quality of Care and Quality of Life

(Section C) The facility must provide, based on the comprehensive assessment and care plan and the preferences of each resident, an ongoing program to support residents in their choice of activities, both facility-sponsored group and individual activities and independent activities, designed to meet the interests of and support the physical, mental and psychosocial well-being of each resident, encouraging both independence and interaction in the community.

How to implement? Meaningful activities are useful beyond recreation. They can be used to respond to behavior, mood and pain. Activities should be used in various forms 24/7. Activities can be situational and and easily set up by both resident and staff. They must be realistic. Understand that group activities planned for during the day won’t work for evening or late night.

F-TAG § 483.75 Quality Assurance and Assessment

(Section O) Facility must keep the existing Quality Assessment and Assurance committee requirements in place by designating key members to meet quarterly to identify quality deficiencies and develop plans of action. The committee should include staff with direct responsibility for resident care including activities staff members.

How to implement? Understand there is a new Care Planning Regulation that says advanced notice is required to be given to a resident if changes are to be made to their day to day living. You  need to explore options and collaborate with the resident.The facility must provide the regulations in a language and format that can be understood. They must be culturally competent as well as accessible for those with disabilities (like hearing or vision impairments).