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state DOH website includes an explanation of the survey process
and the ratings that result. A summary is posted on the website
and a full report can be ordered electronically. The summary gives
an overall rating and lists areas in which deficiencies were found.
The
New York Department of Health (DOH), overseen by the federal Center
for Medicare and Medicaid Services, conducts a survey at each nursing
home every 8-15 months.
A
survey team arrives unannounced, observes, speaks to staff, residents,
families and ombudsmen, and reviews records. If the surveyors find
violations of regulations, they note them in a Statement of Deficiencies
(SOD). The full survey report describes each instance of code violations
that were observed and notes which regulations were violated.
Deficiencies
are characterized by severity from the least serious “potential
for harm” to the most serious “immediate jeopardy.” They are also
characterized by scope as “isolated,” “ pattern” or “widespread”.
A
nursing home administrator must respond to a Statement of Deficiencies
with a Plan of Correction stating what the facility will do to correct
the violations and prevent further non-compliance. Surveyors may
revisit the facility to check implementation but often will accept
a written assurance that the plan has been implemented.
How
Survey Results Can Help Consumers Evaluate and Choose a Nursing
Home
Consumers
considering a nursing home will want to know what was found in
the latest survey. At the same time, they will want to keep in
mind some factors that affect the usefulness of this information.
Rating systems, books and recommendations that are based on survey
results are limited in the same ways.
Realistically,
you can expect most homes to have deficiencies in each survey.
Survey
reports appear on the websites several months after the survey
is completed and remain until several months after the next survey,
which is likely to occur more than a year - up to 15 months later.
Conditions, and staff, change in nursing homes. Sometimes a bad
survey result inspires significant improvement in care at a home.
Surveys
are designed to enforce a minimum standard of care; they focus on
problems and not on things a facility may do especially well.
Surveys
record one moment in time and use only a sample of records, residents
and staff. Published reports can be 6-21 months old.
Surveys
do not provide accurate comparisons because approaches to surveys
can vary greatly among individual surveyors, in different parts
of a state, at different moments in time. In a recent, extreme example,
70% of New York City nursing homes received deficiency free surveys
for a period. hese were followed by a corrective period with intensive
surveys that resulted in long lists of deficiencies at homes.
If
you are choosing a nursing home, you will want to know what is in
its survey report but you will also want to consider factors not
included in surveys:
•
What other families and knowledgeable professionals think of a
home’s overall quality, over a longer time
•
How responsive a home is when residents and families ask for help
with problems
•
How a home responds to a problematic survey report and
•
What positive programs or qualities exist in the home
The
survey report information can help warn you away from some facilities
and prompt questions about others.
•
Very serious sanctions, like fines, and many deficiencies ranked
as serious and widespread are serious warning signs. Another red
flag is repeated deficiencies of the same kind (you will have
to request past surveys to compare; only the most recent summary
is on the website)
•
The areas cited for deficiencies in the last survey can focus
your questions when you do further research and when you visit
a facility. You can check whether the plan of correction has been
implemented and whether a home has responded positively in other
ways to improve problem areas.
How
Survey Reports Can Help Consumers Improve Care in Their Nursing
Home
If
you or your relative is now living in a nursing home, you will want
to know what the most recent survey found. You may have spoken with
the surveyors when they were doing the survey at the home. (Signs
with contact information are always posted inviting residents and
families to do this.) The latest survey must be posted in the facility
with the plan of corrections after it is accepted by DOH.
•
You are in a better position to interpret the survey findings
than someone evaluating the home from the outside, but the factors
that limit what a survey report can tell you still apply.
•
Residents and their regular visitors can use the survey information
in many ways. A family and friend’s organization (or family and
friend’s council) at the home can also use the survey report to
help bring about improved care.
•
The deficiencies cited in a survey can alert residents and families
to problem areas so that they can give those areas special attention
when monitoring the resident’s care.
•
Family organizations may make improving care in those areas part
of their advocacy agenda.
•
Residents, their regular visitors and family organizations are
in a good position to make sure the home implements and continue
any plans of correction.
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