New nursing homes legislation

It is incumbent on all involved in the provision of Older Peoples Residential Services to familiarise themselves with the new legislation, writes Adrian Ahern.

Adrian Ahern
Adrian Ahern

It is incumbent on all involved in the provision of Older Peoples Residential Services to familiarise themselves with the new legislation, which came into operation on July 1 of this year.

The Health Act 2007(Care and Welfare of Residents in Designated Centres for Older People) Regulations 2013 (S.I. No. 415 of 2013) has revoked the previous regulations.

There is a reduction in the number of regulations which are now arranged in 11 sections with six schedules, and while similar to the previous regulations contain many significant changes. The schedules are linked to the corresponding regulation and make them more understandable.

This article attempts to highlight the main changes but does not offer an interpretation or an exhaustive outline of the regulations.

The Statement of Purpose (SOP) no longer requires notification to the Chief Inspector before changes can be made and the requirement to make it available to all residents is also removed. The Registered Provider (RP) is now required to review and revise the SOP at intervals of not less than one year.

The new regulations provide a legal underpinning of the policy “Towards a Restraint Free Environment in Nursing Homes.”

Written policies and procedures are required to be prepared, adopted and circulated to all staff by the RP. Schedule 5 sets out the policies required. The RP shall review such policies at intervals not exceeding three years.

The RP is required to arrange, in so far as is practical to meet the assessed needs of the individual through Individual Assessment and Care Planning. The Person in Charge (PIC) shall arrange this assessment immediately before or on admission and shall prepare a care plan based on this assessment no later than 48 hours after the person’s admission to the centre. Formal reviews of this care plan are required at intervals not exceeding four months, (had been three month intervals), family members may be involved in this process and may be given copies of the care plans with the consent of the resident. The care plan should be reviewed and revised more frequently if the residents condition so warrants.

The new regulations provide a legal underpinning of the policy “Towards a Restraint Free Environment in Nursing Homes” by including in section 7 requirements around managing behaviour that is challenging.

The PIC is required to investigate any incident or allegation of abuse, previously the PIC was required to record and take appropriate action. (Section 8).Where the PIC is the subject of the allegation the RP shall investigate or nominate an appropriate person to investigate.

All unexpected deaths are now to be notified and when the cause of death has been established the Chief Inspector is to notified in writing by the PIC.

The RP is required to ensure residents have access to independent advocacy services, as far as reasonably practical.

Section 10 contains new provisions in respect of residents with communication difficulties including a requirement to have these detailed in their care plan and that staff be made aware of specialist needs.

The requirement to provide for residents to have facilities to wash, dry and iron own clothes is removed.

End of Life Care section has been amended to remove the requirement to provide overnight accommodation for family and friends. The PIC is required to ensure that appropriate arrangements are made to facilitate families, etc.

The requirement for the PIC to have a gerontology qualification has been removed, but a new requirement to have a post registration management qualification in health or related field has been introduced. The qualifications and their level are not specified. The requirement to have an RGN on duty at all times has now been amended to specify a registered nurse, this permits RPN and ID nurses be the nurse on duty.

The requirement to have a nurse on duty at meal times and when refreshments are being served has been removed, however, adequate numbers of staff must be available to assist residents at meals.

The Directory of Residents as outlined in schedule 3, no longer requires the inclusion of PPSN and ethnic origin of residents.

The Residents Guide no longer has to include a summary of the Statement of purpose, the recent HIQA inspection report or the name, address and telephone number of the HIQA Chief Inspector. There is now a requirement to include a section outlining “visiting arrangements”.

Certain records required under Schedule 4 to be retained for a period of not less than four years, formerly seven years.

Insurance (Regulation 22) has been amended to remove the liability to any resident for €1,000 per item and the registered provider is now required to provide insurance against injury to residents and may also insure against other risks.

Regulation 23 outlines requirements for the RP to provide sufficient resources, clearly defined management structures. An annual review of quality and safety of care is required of the RP and this to be made available to residents and Chief Inspector if requested.

Regulation 24 requires providers to advise residents on admission the terms of residency and give a clear description of what services are to be provided and the fees involved. Any other service which the resident may avail of but which is not included in the Nursing Home Support Scheme or any other health entitlement should also be specified. The previous requirement was to do this within one month of admission.

The RP is required to ensure that a risk management policy is in place, to include “abuse”, accidental injury to visitors and to have a plan in place for responding to major incidents.

The responsibilities of the RP in provision of medicines and pharmaceutical services to residents are outlined in section 29. These were not included in earlier regulations.

All unexpected deaths are now to be notified and when the cause of death has been established the Chief Inspector is to notified in writing by the PIC. Where an incident/event as specified in schedule 4 occurs the Chief Inspector is notified in writing within three working days by the PIC.

Where no such notifiable event occurs a nil return will be made six monthly by the PIC, rather than the previous quarterly return.

Each centre is required to provide an accessible and effective Complaints Procedure to make it available to families and to include an appeal procedure.

In the main these regulations are to be welcomed, however it is likely difficulties will be encountered in their application and clarifications will I’m sure be required as care centres   implement them.

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