The Center for Medicare & Medicaid Services (CMS) creates guidelines for long term care facilities (nursing homes) that receive federal funding via Medicaid and Medicare.  Licensed state surveyors perform annual checkups on nursing homes to make sure that these facilities are meeting the expectations of CMS—if not, those facilities are ineligible for CMS reimbursement.

In June 2009, CMS updated their guidelines for long term care facilities (nursing homes) in several ways.  Out of the many changes made, the new “Homelike Environment” guideline is one of the most revolutionary.

Section §483.15(h) Homelike Environment

The actual CMS guideline reads, “The facility must provide a safe, clean, comfortable and homelike environment, allowing the resident to use his or her personal belongings to the extent possible.” CMS interpretation of this guideline suggests that, “A ‘homelike environment’ is one that de-emphasizes the institutional character of the setting, to the extent possible, and allows the resident to use those personal belongings that support a homelike environment.” What this means for nursing homes across the nation, is that sweeping changes will have to be made gradually to transform and deinstitutionalize these facilities.

Some of the more drastic “homelike environment” changes include:

• Removing overhead paging and piped in music.
• Removing institutionalized signage and labeling (such as closet and bathroom labels).
• Removing medicine carts and centralized nursing stations.
• Discontinuing long term use of patient monitoring systems that use audible alarms.
• Eliminating mass-purchased furniture displayed throughout the building.

Homelike Environment Compliance Expectations

Obviously, many of these CMS homelike environment suggestions represent sweeping changes for many nursing homes throughout the nation.  CMS has stated that these guidelines have been effective since June 12, 2009; but in their own words they don’t expect most nursing homes to be able to meet them immediately.  However, they are expecting nursing homes to actively pursue the new guidelines—or face the consequences:

“Many facilities cannot immediately make these types of changes, but it should be a goal for all facilities that have not yet made these types of changes to work toward them. A nursing facility is not considered non-compliant if it still has some of these institutional features, but the facility is expected to do all it can within fiscal constraints to provide an environment that enhances quality of life for residents, in accordance with resident preferences.”

Meeting Homelike Environment Expectations

New technologies exist, such as Dalcon’s patient care communications system Dalcon Alert, that help nursing homes meet numerous “Homelike Environment” expectations. However, CMS has also stated that physical changes alone won’t fit the bill of a “Homelike Environment.”  They are expecting serious culture change by nursing home staff; including a shift towards person centered care, and quality staff-to-resident relationship building.