Nursing Homes: Addressing the Factors Underlying Understatement of Serious Care Problems Requires Sustained CMS and State Commitment
DIANE Publishing, 2010 - 78 pages
Under contract with the Centers for Medicare and Medicaid Services (CMS), states conduct surveys at nursing homes to help ensure compliance with federal quality standards. Over the past decade, there have been reports on inconsistencies in states' assessment of nursing homes' quality of care, including understatement -- that is, when state surveys fail to cite serious deficiencies or cite them at too low a level. In 2008, there was a report that 9 states had high and 10 had low understatement based on CMS data for FY 2002 through 2007. This report examines the effect on nursing home deficiency understatement of CMS's survey process, workforce shortages and training, supervisory reviews of surveys, and state agency practices. Illus.
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actual harm agency directors reported agency practices AHFSA assess citing deficiencies CMS guidance CMS regional office compliance conducted contributed to understatement deficiency citations Deficiency Determination descriptive statistics eight state agency ensure evaluation external pressure facilities favored nursing home federal comparative surveys federal monitoring surveys federal observational surveys federal quality standards federal surveyors fiscal years 2002 identify deficiencies immediate jeopardy levels inexperienced surveyors interviewed low-understatement Medicaid Medicare noncitation practices nursing home deficiencies nursing home industry nursing home operators nursing home surveyors nursing home surveys ongoing training Oversight percent of surveyors Percentage potential programs QIS methodology recommendations reduce understatement response rates Scope and Methodology scope and severity severity level staff standard surveys survey accuracy survey activities survey agency directors survey record survey teams surveyor training surveyor workforce surveyors nationwide surveyors reported surveys with deficiencies understatement of deficiencies vacancy rate Washington workforce shortages workload written guidance zero-understatement