CMS Tag F741 Non-pharmacological Approaches – Adjusting the environment to be more individually preferred with comfortable sound levels

CMS Tag 741 includes a long list of examples of individualized, non-pharmacological approaches to help meet behavioral health needs. We will be reviewing all of them. Food preferences, exercise, pain relief, individualizing sleep, dining and bathroom routines, and preferred lighting   have been discussed in previous articles and now we highlight:

• Adjusting the environment to be more individually preferred and homelike (e.g., using soft lighting to avoid glare, providing areas that stimulate interest or allow safe, unobstructed walking, eliminating loud noises thereby reducing unnecessary auditory environment stimulation);

Let’s start with CMS regulation and Guidance.

CMS Tag F584 Safe, Clean, Comfortable Homelike Environment includes

– §483.10(i)(7) For the maintenance of comfortable sound levels.

DEFINITIONS §483.10(i)

“Comfortable sound levels” do not interfere with resident’s hearing and enhance privacy when privacy is desired and encourage interaction when social participation is desired. Of particular concern to comfortable sound levels is the resident’s control over unwanted noise.

Under contract with CMS as the facilitator of the Creating Home National Symposium on Culture Change and the Environment I was invited to author a background paper to set the stage for the symposium. Below are some excerpts from The Environmental Side of the Culture Change Movement available at my website edu-catering.com. I am going to just give my advice from what I’ve learned that we all could do to improve noise. So all of the following is from my own authored paper which I recommend if you are interested in culture change and the environment.

In the famous CMS contracted study Measures, Indicators, and Improvement of Quality of Life in Nursing Homes which collect data from 1,988 people living in 40 nursing homes in five states, people referred to “noxious noise” which came from auditory alarms, intercom paging, screaming or calling out by residents, “musak” [piped in music]  and loud yelling or calling out by staff.

When it comes to noise, 30 A-weighted decibels (dB(A)) is considered comfortable by the World Health Organization. In a fall study by Empira Consortium nursing homes, they found 45 decibels was the average at night! Add to this, we speak 15 decibels louder than background noise to be understood making it even louder.

Did you know workplace environment noise is protected with OSHA regulations but not healthcare settings?

Noise is disorienting to older adults, especially those with hearing impairment. How many people in the home you represent have hearing loss? Hearing loss is very prevalent at older ages. It also correlates strongly with depression which is understandable as it creates isolation. We can affect this.

Because floors, walls and ceilings tend to be hard and sound-reflecting they cause reverberation – a continuation or echoing of the sounds – exasperating the noise level.

Carpet reduces and absorbs noise and special acoustical wall coverings are available. A study in Sweden using sound-absorbing ceiling tiles resulted in improved sleep and satisfaction including team members indicating decreased stress. Drapes and acoustic panels on walls also absorb noise.

Hopefully you are blessed to work in a home that has a silent call system and direct communication to staff pagers or cell phones, if not, it is something to advocate for and most likely will be the norm in the future.

Certainly teams can coordinate cleaning, floor buffing schedules, etc. to minimize noise.

One team I consult with realized carts used at night caused undue noise, they quickly ordered new ones.

What I suggest, no matter your role, is to simply turn these points from the regulations into questions. Surveyors ask about noise levels, so you could too. I suggest to you to be your own surveyor. Here is a list from me to you:

Are the sound levels comfortable for you here?

Do you ever hear loud noises and how do they affect you?

How about,

Alarm/call light ringing/beeping?

Intercom paging?

Any noises from others who live here?

TVs?

Overhead music?

Carts?

Ice Machines?

Buffing floors?

Vacuums?

People talking?

Any other noises?

When author of Old Age in a New Age Beth Baker visited Meadowlark Hills in Manhattan, Kansas on her nationwide tour of homes that changed culture she noted “I heard nothing but the sounds of home: the splash of juice being poured, the clink of silverware, conversation, soft laughter. As Steve Shields said, what was perhaps most striking was what was absent: no beepers, no disembodied voices over paging systems, no clatter of carts rumbling through halls” (Baker, 2007).

Talk about that too, what sounds of home do you miss and do you want to be hearing?

What if we made this our goal? To create as a new definition of noise in a nursing home or assisted living the pure sounds of home? Now we’re talkin’!

Carmen Bowman, MHS, Regulator turned Educator of Edu-Catering: Catering Education for Compliance and Changing Institutional Culture is an activities/engagement/community life, , regulatory compliance and culture change consultant.  She offers new or not-yet-qualified activity director consultation and personalized continuing education for professionals/teams/associations. At www.edu-catering.com join The Be Encouraged Blog, Become a Leader of Normal Life with the eResource GUARDIANS OF NORMAL LIFE: How Activity/ Recreation/ Engagement/Community Life Professionals can Save the World of LTC and share with your team the eBook Individualizing Medication Administration using Regulations. At the Edu-Catering YouTube channel, see documentaries that highlight changed cultures.