Meeting CMS Requirements for Dementia Care, Part II
Jeannine LeCompte, Compliance Research Specialist
The Centers for Medicare and Medicaid (CMS) requires staff at facilities caring for residents diagnosed with dementia to meet rigorous training and service standard requirements, and a failure to do so can constitute fraud.
Title 42 (Public Health), Chapter IV, Subchapter G (Standards and Certification) §483.95(g), “Required In-service Training for Nurse Aides,” states that in-service training for nurse aides must include:
- Dementia management training
- Care of the cognitively impaired for nurse aides providing services to these residents
- Resident abuse prevention
Staff must be able to cope with all the common behavioral symptoms associated with dementia, which may include more than just being confused or trying to leave the facility, and can involve hallucinations, argumentative attitudes, inappropriate screaming, crying out, disruptive sounds, the physical rejection of care ( i.e. bathing, dressing, grooming), and even serious aggression. Other symptoms can include socially and sexually inappropriate behavior.
Dealing with these symptoms can be demanding, and it takes great understanding and a high level of service to cope with such outbursts. Staff must be trained not to react with violence when confronted with aggression. In addition, the use of restraints needs to be carefully monitored. Sexually inappropriate behavior needs to be handled with great care, particularly in the age of seemingly endless sexual abuse allegations.
Preventing these important issues from becoming serious problems requires careful preplanning. Document discussions with the resident, if possible, and family/representative, about possible interventions and a treatment program. This documented program must be drawn up in accordance with individual needs and in consultation with the resident’s medical record.
The care plan should reflect individualized care with a team approach for identifying measurable goals, timetables, and specific interventions for management of behavioral and psychological symptoms. The care plan should also include a description of preventative measures which may be required to control certain behavioral patterns, why such interventions are necessary, and a complete program to monitor the effectiveness of any intervention.
Each program should be developed in accordance with individual needs and requirements, documented and agreed upon by all parties involved, and meet the basic requirement for “resident well-being.”
