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CMS sets LTC ‘resident rep’ standards

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Federal regulators have drafted rules that could help shape the careers of the next generation of personal long-term care (LTC) coordinators.

The Centers for Medicare & Medicaid Services (CMS) have included standards for LTC facility resident “personal representatives” in a new batch of proposed LTC facility regulations.

See also: Home care planning: 4 things LTC planners should know about the new regs

The proposed rules would have a direct effect only on nursing homes and other LTC facilities receiving cash from Medicare and Medicaid. They could have an indirect effect on private insurers’ standards for LTC facilities, and on consumers who are using a combination of public program benefits and private long-term care insurance (LTCI) or other private insurance coverage to pay for LTC facility care.

CMS, an arm of the U.S. Department of Health and Human Services (CMS), has based many of the regulation changes and additions in the proposed regulations on LTC provisions in the Patient Protection and Affordable Care Act of 2010 (PPACA) and a sister law, the Health Care and Education Reconciliation Act of 2010 (HCERA).

See also: But Wait, There’s More!

CMS officials write in a preamble to the proposed regulations that CMS has not updated LTC facility regulations in a comprehensive way since 1991.

In the new proposed regulations, CMS describes the rights of LTC facility residents to “person-centered care,” and the responsibilities of LTC facilities to do as much as possibility to, for example, respond to residents’ concerns about matters such as food, roommates and medications.

CMS also replaces references to the term “legal representative” with the term “resident representative.”

Some LTC advisors help clients and clients’ families deal with LTC providers, or work with case managers and counseling services that help with LTC management.

See also: Congressional panel to support caregivers

Officials suggested that an LTC facility resident could designate an individual to manage the resident’s finances, make decisions about the resident’s care, and participate in discussions about the resident’s care.

“For purposes of this regulation, we would define the term ‘resident representative’ broadly to include both an individual of the resident’s choice who has access to information and participates in health care discussions as well as personal representative with legal standing, such as a power of attorney for health care, legal guardian, or health care surrogate or proxy appointed in accordance with state law to act in whole or in part on the resident’s behalf,” officials write in the preamble. “One individual may or may not fulfill both of these roles.”

Officials note that the scope of resident representatives’ authority may depend on whether the reps are appointed by a court, are named in documents a resident has created before entering the facility, or are acting in an informal capacity.

In most cases, officials say, a resident representative should have the right to get immediate access to the resident. 

Even residents who have been found to be incompetent under the law should still have the right to help shape their care, officials add.

“We believe that it is important for a resident who has been adjudicated incompetent to be treated with respect and dignity and to continue to make those decisions that are appropriate for him or her to make,” officials say. “Continuing to honor these residents’ preferences and involving them in care planning will improve both quality of life and quality of care, resulting in better outcomes.”

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