I clearly remember my introduction to the state nursing home survey (inspection) back when I was a brand new nursing assistant:
- Panicked whispers of “surveyors just walked in” that spread through the building like wildfire.
- Poker-faced surveyors lurking in the hallways and writing mysterious notes on their clipboards.
- Deer-in-the-headlights expressions on the faces of staff corned by surveyors and peppered with questions.
- Nursing assistants scattering into residents’ rooms, hoping they wouldn’t be one of the unfortunate souls selected to be watched while giving a resident a bath.
- Managers praying that they would be far, far away on vacation the week the surveyors appeared.
Has anything changed over the years? Probably not a lot. The state survey remains a stressful event at every nursing home around the country. No matter how well staff do their jobs, it’s still nerve-wracking to be watched and questioned while they provide care for their residents. I’m hoping by better understanding the survey process, you’ll feel more comfortable if you happen to be volunteering while the surveyors are at your nursing home.
If you’ve experienced a state survey in the past, you’ll notice some changes next time the surveyors come calling. This is the result of a new state survey protocol that was initiated in November. The biggest change you’ll see as a volunteer is the fact that each surveyor now carries a laptop computer to record their observations. This means they’ll be out on the units more to observe cares and interview residents instead of spending so much time huddled behind closed doors in the conference room.
What is the purpose of a state survey?
Inspections were first mandated due to legitimate concerns about care in nursing homes way back in the 1970’s. While it’s easy to view surveyors as the enemy, they are actually here to help assure that our residents receive safe, high-quality care. Nursing homes are required to follow a myriad of regulations. The surveyors are an extra set of eyes to look and see that all of these rules are carried out for the protection of the residents.
Who are the surveyors?
The survey team consists of people from a variety of backgrounds. There’s always a nurse, as well as other professionals such as dieticians, physical therapists, and social workers. All surveyors receive extensive training in nursing home regulations and the survey process.
When can we expect a visit from the state surveyors?
State surveyors generally visit once a year. Additional surveys are scheduled due to a variety of special circumstances. For example, a federal team occasionally comes in as a follow-up to a state survey. If a nursing home does poorly during a state inspection, extra visits may be done to assure the deficiencies are corrected. In addition, a complaint from a resident or family member may trigger a survey.
The visits are unannounced. The surveyors want to see the normal, everyday operations of the nursing home. While they usually arrive during regular business hours, surveyors have also been known to pop in during the night shift and on weekends. Therefore, everyone should always be prepared.
Typically, a state survey lasts about 3-4 days. However, we’re told that they may take a bit longer while the surveyors adapt to the new survey process.
What happens during a state survey?
Surveyors are assigned a wide variety of responsibilities that are specifically spelled out in their survey manual. In part, these include:
- Observing meals
- Inspecting the kitchen
- Watching direct resident cares
- Reviewing medical records
- Meeting with the resident council
- Observing activities
- Checking qualifications of staff
- Observing medication administration
- Interviewing residents and/or family members
- Reviewing policies and procedures (infection control, emergency protocols, etc.)
What should I do when the surveyors are here?
- In my experience, the surveyors rarely focus on volunteers. However, I am aware of one healthcare facility that received deficiencies because volunteers didn’t follow policies. They didn’t always knock on doors before entering rooms, and they didn’t always wash their hands according to policy. Be sure to review the information you received during volunteer training and follow these protocols.
- Although surveyors usually interview residents, family members, and staff, technically they can talk to anyone who is in the building. If a surveyor asks you a question and you don’t know the answer, don’t panic. Simply let them know you’ll find out the answer and get back to them. Or refer them to someone who has the information they seek.
- Politely answer surveyors’ questions, but avoid elaborating on other topics. The surveyors need to follow a specific protocol, and the sooner they can finish their work, the better. Then life can return to normal for residents and staff.
- Staff appreciate a smile and an encouraging word from a volunteer during this stressful time. They are often busier during surveys, too, due to the extra time spent answering questions and looking up information. So the staff appreciate your help more than ever during this week.
What happens after the state survey is finished?
Prior to leaving the nursing home, the surveyors meet to come up with a list of deficiencies (ways the nursing home didn’t meet requirements). They also hold an exit conference with a group of staff and residents to review their general findings. It’s usually up to the nursing home to decide who can attend this meeting. I encourage you to sit in on the exit conference if you’re allowed to do so.
After the survey team returns to their home office, they finalize the details of the deficiencies and assign a letter to each deficiency based on what’s called “scope and severity”. This basically involves how seriously the residents are affected and how many residents are potentially affected. You can refer to this graph for more details.
The nursing home must respond to each deficiency with a written plan of how they will correct the problem. Each facility can also decide if they wish to dispute any of the deficiencies. Depending on the level of the scope and severity there can be penalties such as monetary fines or halting of payments for new admissions. Regulations require the nursing home to post survey results, so you can read the report if you wish.
I’m curious to know your experiences with state surveys. Please share your thoughts in the comment section.