Complex health care decisions for skilled nursing facilities and their residents: Adiscussion of recent Centers for Medicare and Medicaid services updates to survey and certification interpretive guidelines for feeding tubes and advance directives

摘要

In September, 2012, the Centers for Medicare and Medicaid (CMS) overhauled the interpretive guidelines for long term care facility surveyors relating to feeding tubes and advance directives. In March of this year, CMS again released revisions to the interpretive guidelines for both feeding tubes and advance directives, via new Survey and Certification Letters (S&C). S&C 13-17-NH clarifies the definition of "naso-gastric tubes," while S&C 13-16-NH focuses in large part on experimental research and advance directives.