At the end of my HOPE Survey got to me!!!!!!!

  1. I am at the end of my HOPE. I just need some input from others who migh help me to find just a small thread of hope again.
    I currently work as a DNS in the state of Washington. I moved here from the midwest three years ago. I came out as an intrem DNS for a large chain to help them work on some homes which the state had put into stop placement multi times.
    Some of the homes I was in, I agreed with the state, but for the most part 80% of them were good clean caring homes.
    Now three years later I am ready to leave LTC in this state. The survey process in the state of Washington is out of control. I do not know where to go for help!
    I have worked as a DNS or consultant in the following states KS, MO, OK, TX, FL, NE, IA, IL. I have never in all the different states I have worked in ever seen surveys like these.
    The are rude, twist your words, intimidate the staff, get in your face, scream at you. Demand to see peronnel files on issues that as far as I am concerned are none of there business. As, in what is the rate of pay.
    90% of the facilities in this state receive IJ and stop placements.....and I have researched this for the past 3 months and this is the facts.
    If any one IDR's or stands up to them then they just come back with a vengence (sp). and they truly do.
    I have seen them put a facility in stop placement and give and IJ and a level H for a resident who is amb. independent and bumpled their forearm on the door going into the room. The bruise was 3cm by 3cm, the resident stated exactly what happened. Now here is the kicker this happened 9 months ago and the surveyors picked this up on a record review on a desk audit.......calls back 12 days after exit and gives a H and a stop placemment. To me this is part of every day life. I bump into things all the time........Is that abuse or neglect NO it is not.
    I received a G level on a resident who is terminal CA, and has been hanging on for 3 years as it is just slowly moving. She is a/o x 3 50% of the time. She developed a Stage II and was healed in two weeks on her coccyx. She was in an acute phase of the CA and we thought for the 100th time on her last breath. She is on a air bed, had increased pain and the pain was being addressed and we choose to not turn and flip her as often as normal as it was causing her increased pain till the adjust pain med took affect, it was care planed that she would more than likely breakdown. so she did get a stage II. It was healed during survey and had been for three weeks, but they gave me a level G because one developed. This facility has a track record of 9 months with NO in house accuried.....and we get one and this is what happenes they give us a level G.
    They were all pissy cause they asked to see an internal QA 24hour report and we informed them they did not have a right to see an internal QA tool. The survey got into my face and informed be they have a right see anything they ask for. I stood my ground and being as controlled as I could said no I do not thinks so. She informed me she would call the field manger and see about this......
    They called their feild mamnger who called her boss who said we were right it is a internal QA form and we did not have to give it to them...So, they came at us with a vengence..............
    and I got a level G for a stage II and a level G for a MS patient who they thought he had declined and we could have stopped the disease process..........
    I guess that none of this makes any since, but I just have no hope left. They took the fight out of me......
    Help...does anyone else feel the same........
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  2. 4 Comments

  3. by   ChainedChaosRN
    Wow.. your surveyors are definitely out of control. I think you need to place a complaint to CMS about this.....or maybe your licensing officer?

    I've seen homes picked on....usually they are corporate chain homes. I think there is alot of politics at the upper level. Those are the facilities that I feel there is no hope for....until ownership changes.

    If you do a IDDR....is it reviewed at peer level? Maybe you can get them wiped off, especially the pressure ulcer if you can prove it was unavoidable and risk factors were assessed and appropriate interventions in place. Maybe the same for the MS patient? If you've not done that before, feel free to PM me, I'll gladly help anyway I can.

    This is a hell of a business, and I feel for you. If you've been consulting then sadly enough, when it comes to surveys it's a matter of how well you play the game. Point - counter point.

    Good luck.
  4. by   Catsrule16
    Have you considered filing a complaint with the CMS's Regional Office? You are in Region X (10). Do you have a way of recording the behaviors of the surveyors? It's a shame there are those out there who are like that. I guess you can tell what I do for a living. Look at my location. Our job as a surveyor is to find what facilities are doing wrong. However, intimidation and belittling is not the way to do it. The State Agencies have performance standards just like the facilities. They are supposed to be available on the CMS web site someplace. It would be interesting to see what that states standards are. Here are 2 names and email address of people at the Region 10 office. The state agencies are contracted with CMS to complete the surveys. If they don't meet the standards, CMS can pull the contract and go with someone else.

    REACH Contact
    Andrew Tartella
    (206) 615-2412
    atartella@cms.hhs.gov

    Partnerships Contact
    Michelle Sawtell
    (206) 615-2412
    msawtell@cms.hhs.gov

    Good for you for sticking to your ground!

    Good Luck... We aren't all bad.:angel2:
  5. by   ktwlpn
    I presently work in the county run home and have worked in several private homes in this area.I have seen the surveyors judge each home by a different set of standards...I have seen the team arrive at the privately run LTC and be greeted at the door by the therapy dog and then led to the pleasant conference room for coffee,fruit and danish...After that we were lucky to see them more then once on each unit-and believe me-I would NOT place a loved on in that home....However where I work now we seem to have almost an adversarial relationship with the surveyors....At this time of the yr the DON puts her secretary on "lookout" status so the minute they arrive on the property each unit is notified-and we scurry around like frightened mice-and we are not to speak to them unless spoken to.....They go through our facility with a fine tooth comb and we get sited for things that may cause minimal harm and end up with a 1 star rating while these other places actually have occurrences of graver consequence but rate higher on that wonderful government web site...I know that meds were seldom dated at the other home and it was not an issue while I was there but it's a major focus where I work now....I have learned that pretty surroundings do not gaurantee adequate staffing in a nursing home-I would like the surveyors to see that also.....The process is too subjective-the whole system is corrupt IMHO...They arrived at my facility yesterday midmorning-thankfullt I only work 3 days this week....yay
    Last edit by ktwlpn on Jun 17, '03
  6. by   Liddle Noodnik
    Originally posted by Rnltc

    Help...does anyone else feel the same........
    I only know the TERROR when these guys are at the door and the a** kissing and the sigh of relief when they leave.

    I don't envy you your position but you must be good at it and enjoy it most of the time. Don't let them take away the 90% that is GOOD!

    You have to reach the point of acceptance like in the serenity prayer

    God grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to hide the bodies of those I can't. Or something like that.

    Seriously, you know they are gonna be donkeys, you have to just accept that no matter what they say you have a stellar facility. Pray for the b... , serve them good coffee, and throw a party celebrating the GOOD "marks" when they leave.

    xo girlie, take a few days off if you can

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