Do You Need a Certificate to Assist With Feeding the Elderly

Topic:
NURSING HOMES;
Location:
NURSING HOMES;

October 22, 2003		2003-R-0762
FEDERAL NURSING HOME FEEDING ASSISTANT REGULATIONS
By: Helga Niesz, Principal Analyst

You asked for a summary and copy of the new federal nursing home feeding assistant regulations ( 68 FR 55528 ).

SUMMARY

Under new federal regulations, nursing homes will be able to hire trained "single-task" feeding assistants to help residents who have no complicated feeding problems but need some assistance in eating or drinking, if that is consistent with state law, under new federal regulations. The regulations require the feeding assistants to function under a nurse ' s supervision. They set minimum requirements for a state-approved training course of at least eight hours, but allow states to require additional training. Alternatively, states that do not approve a training course are in effect prohibiting nursing homes in that state from exercising this new option.

The Center for Medicare and Medicaid Services (CMS) first published the proposed rules on March 29, 2002, in the Federal Register and, following the comment period, published the final rule on September 26, 2003. The new rules take effect October 27, 2003.

FEEDING ASSISTANT REGULATION

The final rule permits a nursing home to use paid feeding assistants to supplement the services of certified nurse ' s aides under certain conditions. The intent is to provide more residents with help in eating and drinking and reduce the incidence of unplanned weight loss and dehydration. States will have the option to approve training programs for feeding assistants, but if they do, they must at least use federal requirements as minimum standards. They can, at their option, add other requirements. Feeding assistants must successfully complete the state-approved training program and work under the supervision of a registered nurse or licensed practical nurse. If a state does not approve a training program, nursing homes located there will not be able to hire feeding assistants.

Prior Rule

Until now, there was no provision in federal regulations for the use of single-task workers such as paid feeding assistants in nursing homes. Prior regulations required that qualified nursing staff (at least at the level of a nurse ' s aide) provide assistance with eating and drinking. This group of personnel includes registered nurses, licensed practical nurses, and nurse ' s aides who have completed 75 hours of training. But volunteers, who are usually family members, may also feed residents without nurse ' s aide training.

Feeding Assistants Already Used in Wisconsin and North Dakota

The introduction to the regulations refers to positive experiences in two states that have already used feeding assistants on a pilot basis: Wisconsin for seven years and North Dakota for a few years. It states that Florida and Illinois have passed laws permitting such single task workers but have not yet implemented them.

Purpose of Changes

Nursing homes in many states report a continuing shortage of certified nurse aides, according to the CMS introduction to the final rule. Nursing homes are finding it increasingly difficult to train and keep sufficient numbers of qualified nursing staff, especially nurse ' s aides, who perform the majority of resident care tasks. Feeding residents is often a slow process and competes with more complex tasks, such as bathing, toileting, and dressing changes, as well as urgent medical care. Residents may need help in feeding themselves for a variety of reasons. For instance, they may have cognitive impairment which makes them forget to eat or forget how to eat without prompting; impaired swallowing caused by muscular weakness or paralysis; a tendency to choke or inhale food; dental problems; or poor muscular or neurological control of their arms and hands caused by Parkinson ' s or other diseases.

In a September 25, 2003 press release, Health and Human Services Secretary Tommy G. Thompson said, "By permitting the use of trained feeding assistants, nursing homes will be able to provide their residents with better care, especially during the busiest times of the day - breakfast, lunch, and dinner. Nursing homes will now be able to free their nurses and nurse aides to help them focus on their residents' other health care needs and on those residents with complex feeding problems. This means that residents will be able to receive better nutrition and care." Tom Scully, administrator of CMS is also quoted as saying, "We expect that these feeding assistants will take some of the pressure off of the nurses, nurse aides and other staff by allowing them more time to provide some of the more complex tasks such as bathing, toileting and changing dressings." The press release is available at: http://www.hhs.gov/news/press/2003pres/20030925.html

Training Requirements

Under the new regulations, CMS requires feeding assistants to successfully complete a state-approved training course that meets the following minimum federal requirements. The regulations allow states or the nursing homes themselves to impose additional requirements (42 CFR 483.35, 483.7, 483.75).

The minimum requirements are eight hours of training covering relevant items from the nurse ' s aide training curriculum, including:

1. feeding techniques,

2. assistance with feeding and hydration,

3. communication and interpersonal skills,

4. appropriate responses to residents ' behavior,

5. safety and emergency procedures including the Heimlich maneuver,

6. infection control,

7. resident rights, and

8. recognizing resident changes inconsistent with their normal behavior and the importance or reporting those changes to the supervising nurse (42 CFR 483.160).

Selection of Residents for Feeding Assistance

Under the regulations, the nursing home must select the residents to be helped by the feeding assistants based on the charge nurse ' s assessment and the resident ' s latest assessment and plan of care. A facility must ensure that selected residents have no complicated feeding problems. Those who require more specialized help will continue to be fed by the nurse ' s aides or by nurses (42 CFR 483.35(h)(3)).

Supervision

Feeding assistants must work under the supervision of registered nurses or licensed practical nurses (42 CFR 483.35(h)(2)(i)).

Emergency Procedure

A feeding assistant must call a supervising nurse on the resident call system in case of an emergency or need for help (42 CFR 483.35(h)(2)(ii)).

Payment

Feeding assistants can be paid by the nursing home or by arrangement with another agency or organization (42 CFR 483.301)

Use of Non-Health Care Staff

The homes can also use staff who are not health care personnel as feeding assistants if they complete the training program (42 CFR 483.75(q)).

Resources

The final regulation (enclosed) (68 FR 55528, 9/26/03) and the proposed regulation (67 FR 15149, 3/29/02) can also be found at: http://www.access.gpo.gov/nara/index.html .

The enclosed letter from Congressmen Henry A. Waxman and Charles E. Grassley expressing their objections to the new rule, including that it does not solve the understaffing problem, the eight-hour training is inadequate, there is no federal oversight of the state-approved courses, and the requirement to work under a nurse ' s supervision is too broad and lacking in specific standards, can be found at:

http://nccnhr.newc.com//uploads/GrassleyWaxmanLtr092603.PDF

Articles related to this issue can be found at:

http://www.directcareclearinghouse.org/news.jsp

http://www.nsclc.org/news/03/10/feedassist_nf.htm

http://www.mercksource.com/pp/us/cns/cns_newsarticleprint.jsp?id=201547

HN:ro

gorskipriatter.blogspot.com

Source: https://cga.ct.gov/2003/rpt/2003-R-0762.htm

Bagikan Artikel ini