New Report on Nursing Homes

The Long Term Care Community Coalition has released a new report, Safeguarding Nursing Home Residents  and Program Integrity A National Review of State Survey Agency Performance. The 30 page report looks at several topics, including resident harm, inappropriate use of antipsychotic drugs , staffing and treatment of pressure ulcers. The report makes a series of recommendations for CMS and state survey agencies:

1. Re-commit to their mission as enforcement agencies. Residents and their loved ones depend on enforcement agencies to ensure that providers are meeting – or exceeding – standards of care. Tax payers depend on CMS and the SAs to assure financial integrity of the billions of dollars spent each year on nursing home care. However, too often (in our experience), CMS and the individual SAs treat the industry as their client, and its interests as paramount, rather than those of the residents, their families and tax payers.

2. Improve resource allocation. CMS and the SAs should be dedicating their limited resources to fostering vigorous oversight, not training, engaging or otherwise trying to encourage providers to attain the minimum standards of care for which they are already being paid to achieve…

3. Comply with federal Survey Agency requirements. CMS and the SAs should focus efforts on achieving both the letter and the spirit of the law, regulations and the State Operations Manual….

4. Improve performance assessment & integrity.

a. CMS and the SAs should improve training and direction of surveyors…

b. The SAs should collect and assess data on their survey teams’ identification of deficiencies and identification of harm and assess these data in relation to relevant measures (including, inter alia, antipsychotic drug use, staffing levels and pressure ulcer rates)…

c. CMS should conduct, on a regular basis, similar performance assessments of the SAs and the CMS Regional Offices to identify and address weaknesses in quality assurance and oversight. CMS should include in its assessment an analysis of SA complaint handling that includes review of a sampling of actual complaints to determine if they were appropriately investigated and resolved.