"State's Here!": Demystifying the Long-Term Care Survey
Everybody dreads it: that morning when a group of official-looking people walks into their facility and announces the beginning of the annual survey. Here are a few clues as to how to help make yours go smoothly, what surveyors are looking for, and why we do what we do.
SpecialtiesGeriatricArticle
It's the same every year: a contingent from "The State" invades your facility and commences with scrutinizing your work, poring over your records, nosing around the kitchen and dining areas, and asking endless questions. Managers who are rarely seen outside their offices suddenly become helpful, wiping down dining tables and pushing wheelchairs, while everyone from charge nurses to housekeepers strive not to show their nervousness as surveyors watch them perform their duties.
I know it seems as though we are only there to catch you making mistakes and taking poor care of your residents. I was on the receiving end of state surveys for years, so I can empathize with you and understand how it feels to have State in your building. Here are some tips from a nurse who went over to the "dark side" that may help you cope during your next one.
We are not there to intimidate you
In fact, newer surveyors are taught specifically NOT to be aggressive or make people feel bad. Respect and cooperation between surveyors and staff is the best way to accomplish our mutual goal of providing quality care to residents.
We are not there to "dig up the dirt"
However, we do have a job to do, and that is to assure that residents are being treated with the care they deserve, as well as enforce the regulations governing that care. If your facility receives a few citations, it's not because we think you're terrible, it's because we've found deficient practices which are not in accordance with the CFRs (Code of Federal Regulations). And in case you're wondering, we don't make these up as we go along; we are bound by strict rules to be factual and objective in citing deficiencies.
Here are some of the things we look at when we visit you
Obviously, we're going to pay a lot of attention to nursing and related services, and the emphasis often changes. For example, right now we're focusing on unnecessary medications and antipsychotic use in dementia patients; while a few years ago, it was use of alarms and restraint reduction. We will also review sanitation, make observations of the dining experience, work with the fire marshal on fire and life safety, and ensure that resident funds are being managed properly and that employees of the facility have had background checks done.
"Just the facts, ma'am"
If you are interviewed by a surveyor, try not to let emotion get the better of you. We know you're nervous, but we didn't pick you because we suspect you of anything; we need information that only you, and perhaps a few of your co-workers, can give us. It will take less of your time if you just answer our questions rather than volunteer your opinion of a given situation. The exception to this is when you are aware of a deficient practice and nothing was done to correct it when you reported it to your supervisors; even then, we'll probably ask you only the who, what, when, where, and why.
We can't fix the facility's problems
Sometimes we will offer technical assistance in the case of an issue that needs to be addressed, but doesn't quite rise to the level of a citation. Otherwise, we are not permitted to advise a facility on how to comply with the CFRs; it's not our job to tell you what you need to do to correct deficiencies or how to deal with staff members who may have committed errors that drew our attention to a specific area of concern.
For managers: Please make sure that all MDS assessments are coded correctly and submitted in a timely fashion
If this most basic element isn't done right, it will require us to look further into your documentation systems. 'Nuff said.
And lastly.....
A surveyor with a tablet computer in her hand is not your enemy
Believe it or not, we're on the same side---we ALL want SNF patients and LTC residents to receive the best possible care. Yes, we know it can be overwhelming to do a med pass with someone standing next to you and watching your every move. It's nerve-wracking to do peri-care on a resident while a surveyor stands on the other side of the bed taking notes. Just remember that most of us have been there ourselves, and we know exactly how it feels.
In future articles I'll discuss more in-depth the Quality Indicator Survey (QIS) and how it differs from the traditional survey process, as well as the care areas that tend to draw the most scrutiny from surveyors.
