In 2018, Illinois was ranked 50th in the nation for direct care nursing hours per resident per day, and were the second worst in the nation for long-stay residents receiving inappropriate use of antipsychotic medication. The American Association of Retired Persons (AARP) of Illinois, began to lobby lawmakers to make Illinois nursing homes safer, and their efforts intensified during the pandemic. In mid-December 2020, the Illinois Joint Committee of Administrative Rules approved several rules to improve the quality of care in Illinois nursing homes.
The approved rules include:
- Requiring healthcare officials to obtain written, voluntary, informed consent from a nursing home resident or a surrogate decision maker before administering a psychotropic drug
- Educating nursing home staff on the policies related to residents’ informed consent policies and procedures
- Providing appropriately strong remedies for informed consent violations
- Requiring the Illinois Department of Public Health to verify and enforce compliance with minimum staffing requirements
- Making information about facility-specific staffing levels and violations available to the public; and
- Providing appropriately strong remedies for minimum staffing violations
AARP efforts to lawmakers intensified during the pandemic when staffing shortages increased. During the pandemic, more than 85 percent of nursing homes reported having staff who tested positive for COVID-19, with more than 30 percent of the nursing homes reporting a shortage of nurses and aides, per Centers for Medicaid & Medicare Services (CMS).
Issue
Shortage of nursing home staff has always been a concern for nursing home leaders and lawmakers. The pandemic has now intensified the staffing shortage in nursing homes across the country. Emergency preparedness should include reviewing staffing levels and developing a plan for alternate staffing should the pandemic cause a staffing crisis. Additionally, all appropriate staff should be trained on the facility’s policies and procedures for psychotropic drug administration, including informed consent requirements.
Discussion
- Review policies and procedures for ensuring sufficient numbers of staff and also for psychotropic administration. Review policies and procedures for emergency preparedness, including a staffing plan.
- Train staff on psychotropic usage requirements and informed consent policies and procedures. Document that trainings have occurred, and place proof of attendance and competency in the employee’s education files.
- Periodically audit to ensure that the facility’s policy and procedures on psychotropic medication use are being followed by appropriate staff and that each one demonstrates understanding and competency. Determine that psychotropic drug usage does not increase because staffing has decreased.
DEMENTIA MANAGEMENT – DEALING WITH CHALLENGING BEHAVIORS
RECRUITING NEW EMPLOYEES – PAVING THE ROAD TO OBTAINING COMPETENT STAFF
