A recent proposal by the Centers for Medicare and Medicaid Services (CMS) to regulate paid "feeding assistants" in long-term care facilities has raised concerns among speech-language pathologists about the potential risk to residents with swallowing disorders.
CMS developed the proposal, published in the March 29
Federal Register
, to address shortages in some states of certified nurse aides (CNAs) in skilled nursing facilities. The agency predicts that 10 states will implement the policy, and noted in the proposal that Wisconsin and North Dakota have had serious problems recruiting CNAs and have used feeding assistants. Other states that have expressed an interest include Ohio, Minnesota, Florida, California, and Illinois, the agency says.
According to the proposed language, the feeding assistant is not allowed to feed residents with "clinical conditions that require nursing training, including for example, recurrent lung aspirations, difficulty swallowing, or those on feeding tubes…" CMS adds that the feeding assistant "works under the direct supervision of a registered nurse or licensed practical nurse. This means that a nurse is in the unit or on the floor where the feeding assistance is furnished."
ASHA is preparing comments to submit to CMS addressing the need to protect patients from being endangered by feeding assistants who would have a lower skill level than CNAs. One possible provision would be to identify elements of the completed patient assessment tool, the Minimum Data Set (MDS), that would prohibit the use of feeding assistants.
"I recognize the staffing problem with CNAs, who may give insufficient time to feeding residents because of the pressure of their other duties," said Gwenlynn Reeves, an SLP and the compliance director of audits and education at Sundance Rehabilitation. "But I do have questions. For example, how much and what type of training will these feeding assistants receive? And in terms of patient protection, how accurate is the MDS in identifying people with swallowing disorders?"
Barbara Sonies of the National Institutes of Health adds, "It’s really a double-edged sword. This is really meant as a device to free up nurses’ time. My concern is that the person who has individual needs won’t be adequately served unless the assistants receive training from both the SLP and nurse."
ASHA’s comments will be submitted to CMS in late May. For further information, contact Mark Kander through the Action Center at 800-498-2071, ext. 4139, or by email at
mkander@asha.org
.