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Senior Living

2010-10-01 10:11:00

Nursing home surveys

Question: I just passed a survey party at a construction site and was reminded of a friend saying that nursing homes are surveyed annually. Why do they do that?

Answer: It’s a different kind of survey than you are familiar with. You probably are more familiar with the term audit and that is really what a nursing home survey is. It’s not because they don’t know where they are. All nursing homes who participate in either or both, Medicare and Medicaid are required to be surveyed, or audited, by a team of Nurses who are a part of the state survey agency. State agencies are contracted by the Centers for Medicare, Medicaid Services, ( CMS) to survey nursing homes annually. If CMS is a new term for you, it used to be called the Health Care Financing Administration, (HCFA), or HickFa for short. The purpose of annual nursing home surveys is to ensure the residents of those homes receive quality care. Surveys were actually started to alleviate abuse of nursing home residents, following the reporting of several high profile cases. The survey process originally was to check to see if abuse was occurring and to stop it if so. It was also to prevent abusive practices. The surveyors would enter a nursing home unannounced ( they still do today) and observe care practices, as well as sanitation, nutrition, and environmental conditions. Surveyors at that time contained both Registered Nurses and persons who were well-versed in other than clinical areas, such as maintenance. However, over the years, that has changed and only Registered Nurses are on the teams. Each one is widely trained in care home issues, including such areas as maintenance. Originally surveyors or team members had wide discretionary powers and were able to assist the care homes in correcting deficient practices. In many cases errors were found, but they weren’t intentional. Along with the birth of the survey, was the idea of consequences and ways of measuring how good the care was in a particular nursing home. The scope and severity matrix was an answer to that issue. Scope in a nursing home survey, is designed to indicate whether the instance is isolated, whether there is a pattern of errors, or whether they are widespread. Severity is pretty well self explanatory. Any time surveyors find an error, whether it is in resident care or paper documents, it is cited as a deficiency, or deficient practice and is assigned a letter for location within the matrix. Over the years, as laws and regulations have changed so have the methods and requirements for the surveyors. However, their professional opinion always was a large part of the survey and how deficiencies were cited. Each state had its own team requirements as well as individual surveyors opinions. Many organizations have condemned the wide differences in the way each survey team worked. Complaints were made that due to the large variation in the survey system, the system was not fair. Many new laws were enacted, trying to create a more equitable survey system. The laws proliferated to the point where there were more regulations for nursing homes than there were for the nuclear power industry! And there were still inequities. Finally, it was decided to use the power of the computer and data banks to develop a totally new way of surveying nursing homes in an effort to treat all homes equally. The new survey system is called the QIS (Quality Indicator Survey). Using the new system, surveys are more uniform and the new system is more fair. But I’m not really certain I’m glad about that. Having looked at nursing homes in several states, and actually been an Administrator in two states, I think I’m disappointed. I was proud to be from Kansas, which has had some of the toughest surveys in the nation. I believe they also are the best surveyors in the country. From the first survey I went through as an Administrator-in-Training, to the last one I just went through a few weeks ago, I have always considered surveyors my friends and partners in caring for God’s frail elderly. Staff and surveyors work as a team to ensure the very best care and quality of life for those who are living in nursing homes. Each day, as I watch our staff members take care of the residents I am in awe. The love they lavish upon the residents is beautiful to behold. It is obviously much more than a job to them. It is a calling, a mission they live each day as they care for God’s frail elderly. Perhaps that is why Medicalodges Goddard had such an exemplary survey.