Home Care Survey

HealthyNurse · Jul 10, 2011

What is your role with this agency? Are you the owner? I'm a state surveyor in another state. The best advice I can give you is to read and understand the Medicare Conditions of Participation for Home Health Care. The federal survey protocols for home health agencies recently changed. If you google "State Operations Manual, Appendix B Advanced Copy", you will be able to read about the changes to the survey process. Make sure you are reading the version that was revised in 2011. The State Operations Manual is also helpful because it contains the guidance that surveyors follow when evaluating agencies. Good luck!

caliotter3 · Jul 10, 2011

I was warned by my employer that they would attempt to send the surveyors to visit me at my case so be ready. Just a field nurse at the time. I worried about it all for nothing because they never came.

tewdles, RN · Jul 11, 2011

Yes, if the surveyors are planning to visit a patient you must notify that patient in advance, they have a right to refuse.

nurse955 · Jul 12, 2011

I'm the owner/registered nurse/administrator.

I've read the condition of participation and carry a copy with me. I also have a copy of the home care manual (120 pages)that was printed off the Medicare website.

Thank you so much for your replies.

what is the # 1 item that home care agencies are penalized for?

HealthyNurse · Jul 13, 2011

As far as the tag with the highest frequency of being cited on survey, I couldn't say for sure. I can tell you that the biggest issues that I see are related to documentation and communication. An agency may be providing wonderful care, but if it's not documented, it didn't happen as far as I'm concerned. This is Nursing 101, but you would be surprised how many agencies forget this. And communication is also a challenge in any setting. In home health care, clinicians often tend to think that because a physician is not on site, they are hard to get a hold of, or are challenging to work with, that they just don't need to make the effort and document accordingly. Or there is no collaboration within the home care team.

nurse955 · Jul 13, 2011

HealthyNurse,

Thank you for reinforcing the important of documentation.

You are correct about difficulty of tracking down physicians. I recently had a situatio where I repeated called the physician(s) involved on the case, RN working alongside one of the physicians and it takes a day or so to get a reply.

In the hospital setting, one can usually go up the ladder if no response but how is that handled in the home care setting.

Any suggestions?

PS- Are you a surveyor?

caliotter3 · Jul 13, 2011

My ditecyor

caliotter3 · Jul 13, 2011

Can't fix previous post. My DPCS once said one of the biggest things we got cited for, was that nurses failed to document any patient teaching on extended care cases.

tewdles, RN · Jul 13, 2011

Are you finding other ways to communicate with the docs? Can you fax them, email, page, text, etc?

The surveyors will likely want to visit with each discipline. They will expect to observe excellent bag technique and good standard precautions.

They will want to look at your charts. They may want to look at personnel files, policy manuals, etc.

Thats an off my head guesstimation ... gl

HmarieD · Jul 15, 2011

My advice to you in working with the surveyors is:

1) remain calm.

2) Do not be afraid to say "I don't know, but I will find out and get back to you", rather than trying to BS your way through an answer.

3) When a pt record is requested for review, make sure your clerical staff pulls every single thing from every possible place (filing, etc). Give it a quick look if time allows.

4) Make sure the surveyors have clear directions to the pt homes and someone to follow if necessary, they get really irritable when they get lost and nobody wants that :)

5) Instruct the nurses prior to the home visits to make sure they are clear on bag technique, handwashing, all infection control issues. And, tell them if they make a mistake to stop, acknowledge it, and indicate what they should have done differently, instead of continuing to blunder through. (for instance, if they forget to wash hands and change gloves between removing soiled dressing and applying clean dressing). At least the surveyor will know that is not their usual practice.

6) Answer questions as concisely as possible. Do not get chatty, these people are not your friends and do not sympathize with the hardships you face in your job. Keep it short and sweet.

7) Again - REMAIN CALM. Freaking out only makes people wonder what it is you're so freaked out about.

8) Never enter the room without a notebook. They will inevitably ask for 15 things which you will never remember. Take copious notes.

Good Luck! Remember the survey itself is the easy part, the hard part comes later, when you have to write the Plan of Correction and carry it out.

KateRN1 · Jul 15, 2011

The new survey guidelines concentrate much more on the delivery of patient care. Friends at other agencies have given me the following tips that they were cited for:

* on the service agreement: SN frequency not filled out, no clear indication that pt was offered a choice of agencies, no indication of payer source, no indication if pt has advanced directive or if copies were obtained, no patient signature or date

* on patient interview: pt claims not to know about state abuse and medicare hotline numbers (I've started having pts initial that page in the handbook to show that I talked to them about it), pts don't know who/when to call after hours or in an emergency, pt/cgr not able to state their emergency plan

* documentation: the usual with poor documentation to the goals of the 485, poor follow-up documentation with physicians, lack of documentation of care coordination between disciplines, etc.

That's all I can think of at the moment, will post more if it comes to mind.