CENTER FOR MEDICARE ADVOCACY, INC. DENOUNCES FINAL RULES PERMITTING "FEEDING ASSISTANTS" IN NURSING HOMES

Final regulations drafted by the Centers for Medicare & Medicaid Services and expected to be published September 26, 2003 would allow individuals with as little as eight hours of training to feed nursing home residents. "The feeding assistant rules put residents in danger," said Center attorney Toby S. Edelman. "They allow individuals with minimal training and no supervision to feed vulnerable residents."

"The rules are in fact even weaker than the rules that CMS had proposed in March 2002," she said. The final rules do not require direct supervision of feeding assistants by licensed nurses and do not even require that a licensed nurse be "immediately available to give help" in an emergency. CMS says that feeding assistants can use the resident's call bell to call for help and then, if needed, start the Heimlich maneuver.

Feeding Assistants Will Replace CNAs

CMS says that Medicare will not pay nursing homes any additional money for feeding assistants. "If no extra payment is available," said Edelman, "facilities will pay for feeding assistants by replacing CNAs. Feeding assistants will then begin to do more and more tasks for which they have absolutely no training - transferring residents, taking them to the toilet, bathing. The serious and life-threatening risks to frail residents are obvious."

CMS appears to be willing to turn a blind eye to feeding assistants' performing tasks for which they are not trained. The rules allow feeding assistants to feed residents in their rooms. But residents need to be positioned properly to eat and research confirms that residents who eat while reclining in bed - an all-too-common occurrence - are in danger of developing aspiration pneumonia. Feeding assistants would not legally be allowed to position residents. What does CMS expect feeding assistants to do under these circumstances?

Rules Violate Federal Law

Under the federal nursing home reform law, nursing and nursing-related tasks may only be performed by licensed nurses or by certified nurse assistants who have received 75 hours of training and are found to be competent to provide nursing-related tasks. In July 2001, CMS issued guidance allowing workers without 75 hours of CNA training to "transport" residents. CMS wrote then, "We have identified transporting residents as the only nursing home service that does not require the use of nurse aides with 75 hours of training." Now, reversing course entirely, CMS has decided that one of the most complex tasks that CNAs perform - feeding vulnerable residents who cannot eat on their own - can also be performed by people with little training.

CMS should withdraw these rules immediately, enforce current rules that require facilities to employ sufficient staff to meet residents' needs, and begin work towards implementing the staffing ratios set out in CMS' 2001 staffing report.

© Copyright, Center for Medicare Advocacy, Inc. 04/04/2008