Nutritional Care Considerations Under CMS ROP Phase 2: What you need to know

We all desire optimal quality of life and personalized long-term care for our elders. This has been something we have been trying to achieve in the nursing home setting for decades. As significant innovations to resident care have been made in the long-term care setting, CMS is catching up industry trends by revising the survey process. The revisions reflect advances in the theory and practice of service delivery and safety.  The new survey model, set to begin November 28^th, 2017, places emphasis on person centered care, quality, facility assessment and staff competencies.

Person-centered care promotes the importance of keeping the person at the center of the care planning and decision-making process. The resident/representative needs to be informed, involved, and in control of their care. With the new process, upon entrance, surveyors will immediately go to the residents/representatives and start interviewing them regarding care and services the facility provides. Surveyors will also be watching the first meal served after they enter.  Facilities need to:

• Ask resident/ representative their nutrition goals and how they want the facility to help achieve these goals; provide education and negotiate resident’s wishes as needed to provide for and guide resident in making their best-informed choices; follow-up and adjust care plans according to what the resident wants including any changes in the nutritional plan.
• Provide residents with their food preferences within reason of facility budget and availability of food items; take in to consideration each resident’s normal food intake at home and how this may reflect their well-being.
• Provide meals in accordance with each resident’s typical meal time; Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times.
• Watch food production and delivery to assure food is prepared to meet nutritional needs, food preference/choices are honored, and that food is nutritious and delicious. Speak with residents/representatives during the meal to determine if needs are being met; if not, determine any changes that need to be made.

Facilities need to know themselves, their staff, and their residents. There is not a one size fits all approach. In order to understand what resources are needed to care for their residents, each facility must conduct a facility assessment. Results will be used for staffing requirements, staff competencies, services provided, and establishing a QAPI program. Assessing who the residents are by their background (ethnic cultural, religion) will help plan menus for what residents’ like and favor; will also guide as to proper mealtime service, daily and/or on holidays based on their ethnic, cultural, or religious practices and beliefs.

Employing competent staff and documenting training will be key in implementing these new procedures. Facilities must make certain their staff have the knowledge and skills required to ensure residents are able to maintain or attain their highest practicable physical, functional, mental, and psychosocial well-being and meet current professional standards of practice. Educate staff on each of their tasks/responsibilities using a teach back or demonstration that shows they know and are capable of doing their job.

New regulations can cause a feeling of fear and uncertainty. The dietitians at Nutrition Care Systems understand this and have taken exceptional efforts to understand the new regulations and are available to be by your side, helping you lead your staff in providing clinical and nutrition services with your residents/representatives as the center of their nutritional care.

Staci Bettiker, MS, RD, LDN
Sr. Vice President & COO
Nutrition Care Systems, Inc.

Contact Staci:  sbettiker@nutritioncaresystems.com