State Surveys miss many violations

According to a Government Accountability Office (GAO) report, state nursing home survey inspectors frequently miss care problems in nursing homes.  The findings stated that 15 percent of state surveys failed to cite at least one G through L deficiency.  In nine states, the federal surveyors found missed serious deficiencies in 25 percent or more of the surveys.

   At the D through F tag level, missed deficiencies were over 50% in all but five states.  State surveys failed to identify 2.5 D through F level deficiencies per survey.  The most frequently missed deficiencies were quality of care standards.

   In response the GAO intends to :

1. Require regional [CMS] offices to determine why state surveyors cite a deficiency at a lower scope and level than federal surveyors do.

2. Establish quality controls to improve the accuracy and reliability of information and survey data.

3. Analyze federal comparative and observational survey results.

 

 

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New Five Star Rating System for Nursing Homes

    In December 2008, the Centers for Medicare and Medicaid will launch a new five star rating system.  This new system is designed to allow residents and their families an easy way to understand the assessment of nursing home quality.  This new system is not meant to replace a consumer actually going to the nursing home and visiting with staff, residents and other families, rather, it is just another tool to aid in choosing a nursing home.

    The new system will provide a compiled view of the quality and safety information already on the Nursing Home Compare website and will attempt to make it easier for people to compare nursing homes.  The five star rating system will also serve as an incentive for nursing homes to earn the five star rating by providing an environment of better quality of care.

    More information, including a screen shot of what the proposed rating system will look like can be found at www.cms.hhs.gov/PressContacts/10_PR_fivestar.asp

 

 

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Preparing for your next Nursing Home Survey

Screening of Employees

   Lewis Morris, Chief Counsel to the U.S. Inspector General, recently testified before a subcommittee of the House of Representatives on the topic:  “In the Hands of Strangers:  Are Nursing Home Safeguards Working?”  Reading between the lines of his testimony, nursing homes should expect employee screening to be a major focus area on their next survey.

¨    Screen all staff and prospective staff against the Office of Inspector General’s (OIG) List of Excluded Individuals and Entities.  Screening staff against the LEIE helps ensure that a nursing home does not employ an excluded person and that it does not bill federal health care programs for an excluded person’s work. 

¨    Screen prospective nurse aides and other non-licensed care staff through the use of the state nurse aide registries.  Federal regulations prohibit facilities from employing individuals in certain positions who have been found guilty of certain offenses or who have had findings entered into the registry for abuse, neglect or mistreatment of residents or misappropriation of their property.

¨    Check the registries in other states.  Most facilities check their home state’s nurse aide registries prior to employing an individual.  They do not routinely check the registries in other states, but you should do so if an individual may have worked elsewhere.

Voluntary Compliance Programs

The OIG is currently soliciting public comments on draft Compliance Program Guidances.  This new draft focuses on key areas that surveyors will be looking at:

· Inadequate staffing.

· Poor care plan development.

· Inappropriate use of psychotropic medications.

· Lack of Proper medication management.

· Resident neglect and abuse.

The proposed draft should be studied for potential improvement in these areas.

 

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LB 765: Change Provisions Relating to Certificates of Need

 

 

                LB 765 which went into effect on July 18, 2008 requires a certificate of need (CON) for certain actions by healthcare facilities.  First, if a healthcare facility has an increase over a 2 year period of more than 10 long-term care or rehabilitation beds or an increase of more than 10% of the total long-term care or rehabilitation bed capacity, whichever is less it will require a CON.

 

                Next, a CON will be required if a hospital decides to convert hospital beds to either long-term care or rehabilitation beds and if the total of those are more than 10 beds or more than 10% of the total bed capacity, whichever is less, over a 2 year period.  And finally, if a healthcare facility relocates rehabilitation beds to another facility it will require a CON.

 

                Under the act, DHSS can grant an exemption and certificate of need for up to 3 beds if rehabilitation beds, subject to a moratorium if the average occupancy of all such beds within a health planning region exceeds 80% occupancy during the most recent 3 consecutive calendar quarters and there are no other available, comparable services.

 

 

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