REFERENCE INFO - SURVEY PREPARATION

HCFA has announced significant changes to the survey process for long-term care facilities:

• Surveyors will review facility Quality Indicators prior to their arrival
• Emphasis will be placed on certain Quality Indicators
• Investigative protocols changes regarding subject emphasis and interviewing staff
• Survey schedules are to be staggered and unannounced.

Another development is that, with its “Nursing Home Compare” website (www.medicare.gov/nursing/home.asp), HCFA makes survey results available to all. Intended for consumers to use in choosing a facility, the site organizes facilities by location and includes the results of each facility’s most recent survey as contained in HCFA’s OSCAR database.

Quality Indicators

Beginning in July 1999, state surveyors will be studying a facility’s Quality Indicators before they arrive onsite. They will use the 24 Quality Indicators (QI) developed by the HCFA-funded CHSRA program at University of Wisconsin. The QIs are calculated from MDS data. The 24 Quality Indicators are in eleven groups: Click here to view the complete list of 24 QIs.

• Accidents
• Behavioral/Emotional Patterns
• Clinical Management
• Cognitive Patterns
• Elimination/Incontinence
• Infection Control
• Nutrition/Eating
• Physical Functioning
• Psychotropic Drug Use
• Quality of Life
• Skin Care

Surveyors will be placing emphasis on these QIs, beginning in July 1999:

• Nutrition: prevalence of weight loss (MDS item K3a) and prevalence of tube feeding (MDS item K5b)
• Hydration: prevalence of dehydration (MDS item J1c or a diagnosis of Dehydration in MDS item I3)
• Pressure Ulcers: Prevalence of Stage 1-4 pressure ulcers (MDS item M2a). For this indicator, high risk conditions are identified, including impaired transfer or bed mobility (MDS items G1), comatose (MDS B1), malnutrition (according to ICD-9 in MDS I3), or end-stage renal disease (MDS J5c)

The surveyors will have reports that show the number of residents in each QI, calculated from your facility’s MDS data, and will be looking for numbers that could point to a deficiency.

Investigative Protocols for Surveys

Changes are also in store for how surveys are conducted. An implementation date of July 1999 has been reported for these changes:

• Emphasis on abuse prevention
• Incorporation of the Beers criteria for determining inappropriate medication use by the elderly. (see HCFA transmittal).
• Staff will be interviewed by surveyors on adequacy of staffing at the facility and on why they reached their conclusions, for example care planning decision on triggered Resident Assessment Protocols.

Changes in survey schedules

HCFA is responding to the General Accounting Office study and the White House Quality Initiative by making changes in the survey process for long-term care facilities.

One change is that surveys are to be conducted on a staggered schedule. Effective January 1, 1999, HCFA has revised the State Operations Manual regarding how state agencies conduct surveys of facilities, so that

• At least 10 percent of standard surveys must be conducted on weekends or in the evening/early morning hours.
• Of these 10 percent, the survey must be conducted on consecutive days (including Saturdays, Sundays, and holidays).

To assure surveys are unannounced, HCFA directed the following:

• In a given geographical area, the order facilities are surveyed should be different from previous survey.
• The survey schedule should be varied as to time of day, day of week, time of month, and month from the facility’s previous standard survey
• Survey start time should extend beyond business hours (8 am to 6pm) and should include evening hours (after 7 PM) or morning hours (before 7 am).