THE LONG TERM CARE FACILITY SURVEY PROCESS
HOW THE STATE SURVEYS LONG TERM CARE FACILITIES FOR MEDICARE AND MEDICAID CERTIFICATION
All long term care facilities must be licensed and inspected using state standards. In addition, the Office of Health Facilities Licensing & Certification, Division of Health Care Services, of the Department of Health & Social Services, inspects long term care facilities that provide care to Medicare and Medicaid residents using federal standards. Such inspections are called "surveys. The surveys take place every 9 to 15 months, with an average of every 12 months.
WHY ARE SURVEYS PERFORMED?
Surveys are conducted to make sure that the long term care facility is meeting state and federal standards which spell out very specifically how care must be provided to long term care facility residents. The areas looked at are quality of care and quality of life in the facility, whether residents' rights are observed and whether the facility meets environmental standards of cleanliness and is hazard-free. Facilities that do not meet all these standards must correct these "deficiencies" or they face a variety of sanctions.
WHO PERFORMS THESE SURVEYS?
Surveys are performed by teams of state employees (usually three or four people) who are specialists in long term care facility care. The surveyors have backgrounds in nursing and administration. These individuals must pass a national examination administered by the federal government to qualify as long term care facility surveyors. In addition, surveyors are required to complete specialized training.
HOW DO SURVEYS OCCUR?
Prior to beginning a survey, team members review the long term care facility's background. They look at previous survey results, complaint investigations, incident reports and quality indicators that give information specific to each facility. They also consult with the long-term care ombudsmen assigned to that facility. This gives them an idea of whether there are special concerns or problems that they should be aware of during the survey.
SURVEYS ARE UNANNOUNCED!
The long term care facility is not notified in advance of a survey unless it is an initial survey. When the team arrives at the long term care facility, they place a sign in the lobby informing everybody that a survey is in progress. The idea of unannounced surveys is for the team to be able to see how the facility operates on a daily basis.
HOW DO SURVEYORS CONDUCT THEIR WORK?
Surveyors observe what is going on in the long term care facility; they interview residents, family members and long term care facility employees and they read medical records and other documents. They also meet with long term care facility staff members for clarification of questions. The surveyors summarize their observations to the facility staff at the conclusion of the visit.
WHAT KINDS OF QUESTIONS DO SURVEYORS ASK RESIDENTS AND/OR THEIR FAMILY MEMBERS?
The surveyors want to know what life is really like in the long term care facility. They spend time talking to residents asking how staff treat them, what the food is like; whether residents like and participate in the activities being offered; and how the long term care facility responds when they have a concern or a complaint. Surveyors want to know whether the home provides help to people when they need it with such daily tasks as bathing, dressing, eating meals, going to the bathroom and getting in and out of bed. They also talk to family members of residents who are "not interviewable", i.e. persons who can no longer speak or who have advanced dementia and other diseases which keep them out of touch with what's going on.
WHY IS IT IMPORTANT FOR RESIDENTS AND FAMILY MEMBERS TO
PARTICIPATE IN INTERVIEWS?
It is important for residents and family members to participate in interviews because they know best what really happens in the long term care facility. It is important they speak very frankly with the surveyors about the home's performance. The home is evaluated primarily on how it cares for its residents.
SHOULD I WAIT UNTIL A SURVEY IF I HAVE PROBLEMS THAT I AM REALLY
CONCERNED ABOUT NOW?
No. Residents and family members should talk to the facility staff immediately about any concerns. If they are not addressed, help can be sought from the long-term care ombudsman or a formal complaint can be filed with the Office of Health Facilities Licensing & Certification, Division of Health Care Services, of the Department of Health & Social Services.
WHAT HAPPENS AFTER A SURVEY IS COMPLETED?
The team meets briefly with long term care facility staff to explain the outcome of the survey. If the facility receives a statement of deficiencies, they are given ten days to respond with a “plan of correction.” A follow-up survey takes place to verify the accurate and timely implementation of the “plan of correction.”
DEFICIENCIES AND PLANS OF CORRECTION- A deficiency is a determination by the
Office of Health Facilities Licensing & Certification that a long term care facility has violated one or more specific licensure or certification regulations. Deficiencies range in scope and severity from isolated violations with no actual harm to residents to widespread violations that cause injuries or put residents in immediate jeopardy of harm. Deficiencies are cited as a result of an on-site inspection. When deficiencies are alleged, the facility is given an opportunity to rebut the findings. If deficiencies are cited, the Office of Health Facilities Licensing & Certification requires the long term care facility to submit a written plan of correction detailing how and when each deficiency will be corrected. In some cases, the Office of Health Facilities Licensing & Certification will direct specific corrective measures that must be implemented. In situations where current conditions at the facility pose a serious risk to the health and safety of residents or staff, the Office of Health Facilities Licensing & Certification can require immediate corrective actions.
Long Term Care Facility Regulations– All long term care facilities in Alaska are required to meet mandatory state standards that set the minimum and essential requirements of care that must be provided.
Enforcement Actions– The information on state and federal inspections and complaint investigations is available from the Office of Health Facilities Licensing & Certification. When reviewing an inspection report it is important to remember that long term care facilities have the right to appeal survey findings and penalties imposed. Such appeals may be pending at the time the report is used. On appeal, the decision of the Office of Health Facilities Licensing & Certification may be upheld or reversed, or a settlement may be reached in which fines are reduced. It is also important to note that inspection reports show only a one-time “snapshot” of long term care facility compliance with established standards. To more fully assess the quality of care provided by a facility, it is important that current and past survey reports by reviewed. You may also wish to discuss the facility’s services and performance with your doctor and family members or friends who have used the facility. Complete survey reports and long term care facility plans of correction, edited to protect patient confidentiality, are available at each long term care facility as well as at the Office of Health Facilities Licensing & Certification. The most recent federal inspection surveys are posted on the CMS Website at www.Medicare.gov/nursing/home.asp
GLOSSARY OF TERMS
CERTIFICATION – A determination that a long term care facility meets the federal care standards for operating a home with Medicaid or Medicare funding.
DEFICIENCY – A failure to meet a federal and/or state standard for care. The most serious deficiencies pose an immediate threat to resident health or safety.
EXIT CONFERENCE – A meeting at that the end of a survey where surveyors review their findings with the long term care facility’s administrator and key staff.
CENTER FOR MEDICARE AND MEDICAID SERVICES (CMS) - A federal agency that oversees the regulation of long term care facilities that are paid by Medicare or Medicaid funds.
LICENSURE – A determination that a long term care facility meets the state standards for operating a home in
OFFICE OF HEALTH FACILITIES LICENSING AND CERTIFICATION – An office in the Division of Health Care Services, Department of Health & Social Services set up to protect the health and safety of the residents in long term care institutions.
OMBUDSMAN – A federally-mandated program. Ombudsman representatives are trained to received questions and complaints and to advocate for residents and families. The Ombudsman Program is administered through the State of Alaska, Mental Health Trust 907-334-4480. There is a Toll Free number 800-730-6393.
Health Facilities Licensing & Certification
Department of Health & Social Services
Division of Health Care Services
4601 Business Park Blvd., Bldg. K
Anchorage, Alaska 99503