Tag F741 Non-pharmacological Approaches – Individualizing Sleep Routines
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 and pain relief in previous articles and now highlight:
- Individualizing sleep and dining routines, as well as schedules to use the bathroom…
Isn’t this good? Isn’t this what everyone wants, their personal, individualized sleep routine?
Yet in so many LTC homes, people continue to be woken according to the institution’s routine, not their individual sleep routine. In my experience this institutional practice boils down to one word … breakfast. Breakfast drives most institutional nursing homes and assisted livings but it doesn’t have to. Breakfast belongs to each home, to each community, the time to hold breakfast is not mandated by any regulation. Most people are unaware of this. It is your home, your breakfast, your system.
Do not be held hostage by your own systems.
What regulations do require is the right to make choices by those who actually live … and sleep … and eat there.
Because there is no regulated, mandatory time for breakfast, your community can decide when they want breakfast and can make it available longer thereby affording choice to those who live there which is required:
CMS Tag 561 Self-determination. Right to make choices about aspects of his or her life in the facility that are significant to the resident.
When I start out just asking people at the beginning of a session what will be significant to you when you live in a LTC home, sleep always comes up. What aspects of your life will be significant to you to be able to make choices about? There are many and yet sleep comes up to the top often.
Many think Tag F809 Frequency of Meals prevents open dining times, however, it too supports choice and will be reviewed in the next article.
Now let’s consider sleep, glorious sleep. How many of us would rather be sleeping? How many of us like to notset our alarm clock? How many of us are getting enough sleep? Could it be, they are us and we are them? They worked hard, they deserve sleep.
“Sleep is like medicine” my mom always said growing up. She would further explain whatever ails you – be it emotional, mental or physical – it will be better in the morning. She was right. I have come to add to my mom’s quote. “Sleep is better than medicine.” Sleep is healing.
So why do we continue to wake people up? One time a certified nursing assistant accurately answered with “because of the almighty schedule.” There’s the “get up” schedule; the meal schedule; the bath schedule; the therapy schedule; the restorative schedule; the medication schedule; the activities schedule/calendar. Isn’t it ironic people are made to fit all these institutional schedules when in fact it is supposed to be the other way around? In fact, look at this regulation, did you know this?
CMS Tag 600 Abuse. Characteristics placing residents at risk for abuse: Policies operate in the interests of the institution rather than residents.
Although most community policies operation in the interests of the institution, that is not what is required! That is not the way it is to go. And there is even more CMS support again at Tag 561 that require the nursing home to honor the person, their preferences and their choices:
CMS Tag F561 Self-determination. Right to choose activities, schedules (including sleeping and waking times), health care and providers of health care services consistent with his or her interests, assessments, plan of care and other applicable provisions of this part.
CMS F561 Guidance: Residents have the right to choose their schedules, consistent with their interests, assessments, and care plans. This includes, but is not limited to, choices about the schedules that are important to the resident, such as waking, eating, bathing, and going to bed at night. Choices about schedules and ensuring that residents are able to get enough sleep is an important contributor to overall health and well-being.
Residents also have the right to choose health care schedules consistent with their interests and preferences, and information should be gathered to proactively assist residents with the fulfillment of their choices. Facilities must not develop a schedule for care, such as waking or bathing schedules, for staff convenience and without the input of the residents.
Residents also have the right to choose health care schedules consistent with their interests and preferences, and information should be gathered to proactively assist residents with the fulfillment of their choices.
Facilities must not develop a schedule for care, such as waking or bathing schedules, for staff convenience and without the input of the residents.
It is wonderful that sleep is included in this list of Non-pharmacological Approaches right at CMS Tag 741. Lean into it. Learn it about each individual’s routine and preferences and begin to take steps to change your rigid systems to flexible ones that honor the individuals who live … and sleep … where you only work. And remember when it comes to sleep, true choice is when a person awakens naturally, their body makes the choice. We all know the benefits: less depression and anxiousness; more alert and energetic. Builds up immune system, protein synthesis, tissue repair, muscle growth. Better cognition, thinking. No more so called “behaviors”. Better mood. Fewer falls. Everything is better.
“Clinical benefits, just by going by the resident’s schedule, have resulted in better sleep, nutrition, moods and other outcomes” stated by an administrator in the CMS broadcast Case Studies in Culture Change 2006/2007.
So, what do you need for a good night’s sleep?
Yes, you too. Sleep is vital for each of us but you get to tend to yourself and your needs as you go. Start asking those who live and sleep where you work, “What do you need for a good night’s sleep and what is your individual sleep routine?” It is fun to go through the typical list of things people need and see what the individual tells you…
Do you need…
Fan/no fan, draft/no draft?
Warmer/colder?
Socks/no socks?
One pillow/more than one pillow? Is pillow right for you?
Are blankets right for you?
TV on/TV off?
Light/no light?
Eye mask/no mask?
Ear plugs/no ear plugs?
A back, neck or hand rub?
A back scratch/er?
Essential oils for relaxation i.e., lavender, bergamot.
Chamomile tea? Other warm drink?
Snack?
It is a wonderful gift to give someone a good night’s sleep. Good sleep is part of health. And, individual sleep routines are in the regulations.
- S. If you represent a setting that is not under federal CMS requirements, many state nursing home regulations mimic federal, many assisted living regulations have similar portions of federal requirements and if nothing else, consider these good requirements standards of practice to follow. Be famous for helping people be well rested.
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 is a co-developer of the Artifacts of Culture Change original/2.0 Nursing Home and first-ever Assisted Living version. 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 five documentary videos plus more that highlight changing institutional culture.
