Quality of life is a fundamental principle that applies to all care and services provided to nursing facility residents. The Quality of Life regulatory requirements at 483.24 (F675-F680) cover Quality of Life, Activities of Daily living, CPR, and activities. F677, ADL Care for Dependent Residents, is the most commonly cited Quality of Life requirement. Last year F677 was cited in over 79% of surveys nationally with over 16% of facilities receiving a F677 citation. So far in 2023, F677 has been cited nearly 1,200 times with deficiencies found in over 78% of the surveys conducted. Learn more about F675-F680 Quality of Life survey deficiency trends…

The regulation regarding ADL Care for Dependent Residents (F677) requires that residents who are unable to carry out ADLs receive the necessary services to maintain good nutrition, grooming, and personal and oral hygiene. Citations are often received in this area related to failing to provide timely incontinence care, not providing adequate assistance with eating, and failing to provide adequate assistance with grooming, for example unkept nails or facial hair.

In FY2022, there were 139 Immediate Jeopardy citations related to Quality of Life requirements. Of these, 132 were related to CPR, 4 were related to ADL care, and 3 were related to Quality of Life. 30% of the Quality of Life Immediate Jeopardies occurred in Minnesota, Missouri, and Texas. So far this year, 33 Immediate Jeopardies have been cited related to CPR.

The regulation regarding CPR (F678) requires that staff provide basic life support, including CPR, to residents requiring such emergency care prior to the arrival of emergency medical personnel and subject to related physician orders and residents’ advance directives. Compliance with this requirement requires facilities to:

      • Have properly trained & CPR certified staff available 24hrs/day to provide BLS, including CPR
      • Properly train staff that CPR should be initiated unless a valid Do Not Resuscitate (DNR) order is in place, obvious clinical signs of irreversible death are present, or initiating CPR could cause injury or peril to the rescuer
      • Have policy and procedures and systems in place to document resident choices regarding CPR and how preferences/orders related to CPR/advance directives are communicated throughout the facility
      • Verify presence of advance directives or wishes regarding CPR upon admission

To learn more about the Quality of Life regulatory requirements, action steps for compliance and survey trends in this area, please plan to join our May Deep Dive into Federal Regulations session where we will review the Quality of Life regulatory requirements, survey procedures for assessing compliance with Quality of Life requirements, examples of how Quality of Life requirements are commonly cited, and strategies for incorporating survey preparedness related to Quality of Life into facility QAPI processes. Learn more and register

Written By: Shelly Maffia, MSN, MBA, RN, LNHA, QCP, CHC, CLNC, CPC
Director of Regulatory Services

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