Tour the Facilities
Activities and Events
Staff and resident interactions
Carefully observe how the staff and the residents relate to each other. By paying attention to the way the workers interact with the residents, you can determine if the staff is caring, sensitive and responsive to the needs of the resi–dents. Another indication of the relationship between the staff and the residents is the appearance of the residents. Just as the appearance of the home indicates whether it would be a nice place to live, the appearance of the resi–dents shows whether they are well-groomed, dressed ap–propriately and cared for by the staff.
Nursing Home Regulations
To be licensed or to receive Medicare or Medicaid reim–bursements for services, nursing homes must meet and maintain certain minimum requirements found in federal and state regulations, which promote and protect the health, safety, welfare and rights of residents.
To ensure compliance with both federal and state regula–tions, the ORS staff inspects nursing homes. Generally, the ORS staff inspects a nursing home before it begins operation and then once every year. If violations or defi–ciencies are found, the ORS inspector makes a record of the infractions. The nursing home must then file a plan of correction demonstrating how it will correct each viola–tion. After receiving the plan of correction, the ORS staff usually conducts a follow-up inspection to make sure the nursing home has remedied the deficiencies.
During an inspection, the ORS staff looks at the care given to a representative sample of residents at the home.
They do not inspect the care given to every resident, but they do look at the physical condition of the home, they talk with residents and staff, they observe the activities at the home and they review medical records.
If the ORS staff inspector finds that a nursing home is not meeting regulatory requirements at any time, the govern–ment can revoke the home’s license and reimbursement or impose another sanction, such as a fine. Any imposed sanctions against a nursing home are based upon the defi–ciencies recorded in the inspection reports.
How to Use the Reported Information
Seriousness of deficiencies
The severity of a deficiency or violation is an indication of the harm that could come to residents. Likewise, the number of deficiencies and the number of residents adversely affected by them give an indication of how widespread problems are in a particular home.
While all nursing home regulations are important, some are more directly related to health, safety and welfare of residents. For example, it would be of greater concern to find a problem with medication errors in a facility than one with failure to keep patient statistics properly, as administrative requirements are not directly related to patient care. Also, close attention should be paid to violations of regulations that are designed to protect patients’ rights.
Further, if a nursing home facility has had fines or other sanctions imposed against it or if it has been threatened with license revocation or decertification by Medicare or Medicaid, you should carefully consider those infractions.
A facility’s plan of correction sheds light on its ability and willingness to solve its internal problems and provide good care for residents. If a nursing home has been cited repeatedly for the same or similar deficiencies in the past, its commitment to addressing and fixing its problems should be questioned. This is especially true if the facility files a similar plan of correction in response to the violation each time. If a facility is cited over and over for numerous or serious deficiencies, this may indicate real problems within the home.
Isolated events or widespread problems?
It is rare to find a nursing home with no deficiencies whatsoever. So, whether a deficiency is a one-time or a common occurrence is of particular importance. Isolated events that have been addressed through a well-thought plan of correction indicate a high level of responsiveness on the facility’s part. Problems that present themselves repeatedly and problems that have the potential to become larger as time progresses are an indication of pervasive issues within the facility.
For example, if a facility is short staffed, improper care may be or may become widespread throughout the home. As another example, a medication error rate of 16 percent reflects a broad and potentially extremely serious problem that could affect a large population within the facility. However, while a medication error rate of 6 percent should not be ignored, it is important to note that this rate is just one percentage point over the allowable federal regulation error rate of 5 percent.