I gave significant thought to a catchy title playing on Watchmen, but ultimately I’m not that clever. Plus, suggesting that reading a nursing home survey is anything close to reading or watching Watchmen borders on fraudulent (even for those disgusted that it was made into a movie). BUT, don’t let my failures in creative writing (or even my failure to come up with a proper metaphor since Watchmen doesn't quite work) dissuade you from reading on. Nursing home surveys are very important and being able to read a survey can be an invaluable source of information into how a nursing home operates. Whether you have a loved one in a nursing home or are going through the process of prospectively considering nursing homes, a survey gives you some insight into issues state surveyors may have found during inspections.
By way of background, nursing homes that accept Medicare and/or Medicaid residents are regulated by an ominous sounding set of regulations known as OBRA—Ominibus Budget Reconciliation Act. In 1987 the Federal Nursing Home Reform Act was attached to the 1987 Omnibus Budget Reconciliation Act (known as OBRA ’87, which would make for a cool band name) and required facilities accepting federal payments for resident care to comply with various statutory requirements. One of the enforcement mechanisms put into place were periodic surveys of the facilities. The federal government contracts with each state to conduct surveys of the facilities located in each state—in Missouri it is the Missouri Department of Health and Senior Services (MDHSS)and in Kansas it is the Kansas Department of Aging and Disability Services (KDADS). In Missouri the state law requires a survey be conducted twice a year, whereas federal law requires a survey every 9 to 15 months. Kansas simply follows the federal law and requires a survey once every 9 to 15 months. In addition to these “annual” surveys, “complaint” surveys are conducted following complaints to the state about care at a specific facility.
Surveys are often lengthy because they frequently include extended narratives from interviews the investigator conducts with selected staff members or residents, as well descriptions of documents such as policy and procedures or medical records. References to staff members and residents are anonymous, often referred to in the survey by letter or number to the individuals. The narrative may be of interest if you are looking for a specific issue or if the survey addresses a complaint you made. But if you are looking for a more general takeaway from the survey, there are a couple of places you can quickly look to get a feel for the nature and severity of any deficiencies.
The first things to consider are the “F-Tags.” These are numbers that reference the type of deficiency found. For example, a survey may reference “F323.” This is in reference to the rule requiring a facility maintain a hazard free environment. The specifics of how the facility violated this requirement can then be found in the narrative. Click here for an excellent resource in explaining each type of F-tag.
The next thing to consider is the severity and scope of the tag. This can often be found under the tag and will be represented by letters A through L. The higher the level, the greater the severity and scope. For a great explanation of meaning of each letter, go here.
Another important thing to consider is whether any penalties were assessed against the facility for the deficiencies. Often, if deficiencies are found, a facility will be required to craft a “plan of corrections” in which it must outline how it will rectify the deficiencies. Sometimes, with more serious deficiencies, a facility can be fined or even lose its reimbursement from Medicare or Medicaid. Nursing homes are required to keep recent surveys on-site for public accessibility. Additionally, if surveys for any facility can be found here.
Nursing home surveys are not the final word on how well a nursing home is caring for a resident. Negligence can occur in the absence a poor survey and a poor survey does not necessarily establish negligence. But surveys are one tool that allow us to see how well a nursing home is providing care to its resident—at least in the eyes of the government. Thus, to take it back to a metaphor that may not quite work, we are all watching the watchmen.
-Ryan
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