Improving the Quality of Care in Nursing Homes (1986) / Chapter Skim
Currently Skimming:
Appendix C: Report of Survey of State Health Facility Licensure and Certification Agencies
Appendix C: Report of Survey of State Health Facility Licensure and Certification Agencies
Pages 315-350
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 315... ...
obtain data on the statutory availability and use by states of various types of intermediate sanctions for enforcing compliance with nursing home standards. The survey was designed with the cooperation and assistance of the officers and board members of the National Association of State Health Facility Licensure and Certification Directors.
|
From page 316... ...
From January to March 1985, staff collected and analyzed the data, which were then used to produce descriptive and inferential statistics, to make interstate comparisons, and to observe changes in survey agency resources and enforcement activities from 1980 to 1984. The survey data were also merged with existing state demographic and nursing home data available from the Medicare/Medicaid Automated Certification System (MMACS)
|
From page 317... ...
Many of the committee's conclusions on the survey process, on state agency resources, and on state enforcement activities are based on survey findings. SUMMARY OF FINDINGS Major findings for each of the eight topics covered by the survey are summarized below.
|
From page 318... ...
All but three handle acute care hospitals, all but two handle home health agencies and hospices, and most also are responsible for board-and-care facilities (33/47~. Survey Agency Personnel and Budget State agencies vary greatly in the size of their budget and staff per nursing home.
|
From page 319... ...
Combined licensing and certification surveys for the average-quality 100-bed nursing home ranged from 1.0 to 12.0 person-days for ICFs (with a median of 5.9) , and from 1.5 to 18 person-days for SNFs (with a median of 6.~.
|
From page 320... ...
All states reported that licensure and certification surveys are combined, with roughly three-quarters always doing combined surveys (33/47~; the remainder combine surveys only some of the time. Seven states indicated that they use a screening or abbreviated survey to determine which facilities should receive a full-licensure or certification survey.
|
From page 321... ...
Thirty-six states reported that the number of standards out of compliance that would cause the nursing services condition to be marked out-of-compliance "depends." Usually they said it depended on "the severity" of the violation. Five states listed specific standards which would put the nursing services condition out of compliance: standards 124, 134, and 181 (director of nurses, 24-hour nursing, and administration of drugs, respectively)
|
From page 322... ...
. ~ authority to Impose criminal penalties t~or patient abuse; 26 have administrative fining authority; 25 have the authority to take licensure records into consideration in certificate-of-need recommendations; 21 have the authority to place a facility into receivership; 19 report having the authority to withhold Medicaid payments to noncompliant facilities; 15 have the authority to issue probationary licenses; 9 have the authority to reduce the Medicaid reimbursement rates of noncompliant nursing homes; and 7 have the authority to appoint a monitor to a facility (see attached copy of survey questionnaire)
|
From page 323... ...
the total number of state agency visits to nursing homes, and (4) the survey agency director's opinion of the survey process regulations.
|
From page 324... ...
States with higher nursing requirements, and those with more monetary resources and more staff/time resources allocated to nursing homes, implement more kinds of sanctions and more sanctions. Larger increases in state licensing funds from 1980 to 1983-1984 are related to fewer enforcement actions; smaller increases are related to more types and numbers of enforcement actions.
|
From page 325... ...
Views on Federal Regulations The majority of respondents believe that current federal certification regulations could ensure nursing home services of adequate quality with certain modifications. A few forwarded specific suggestions for changes.
|
From page 326... ...
Thirteen believe that these standards cannot ensure adequate-quality nursing home services without a major overhaul and reorientation. Regarding the current federal survey procedures, 11 state agency directors think that the regulations work reasonably well as they are; 7 think they would work with some deletions; 20 think they would work with changes and additions; 7 think they would work if the federal government gave states more support; and 2 think they need to be completely revised.
|
From page 327... ...
Forty-six disagreed with the proposal to allow JCAH accreditation to replace surveys. SURVEY QUESTIONNAIRE The attached copy of the IOM Committee on Nursing Home Regulation Survey of Health Facility Licensure and Certification Directors contains the frequencies of responses for each of the questions asked.
|
From page 328... ...
In the questionnaire, "survey agency" refers to the state agency which administers licensure and/or certif ication surveys of nursing homes, and "Medicaid agency" refers to the single state agency which administers Title XIX funds. Thank you very much for your cooperation.
|
From page 329... ...
Does the survey and certif ication unit do any of the following activities concerning nursing homes in your state: Act ivity a. State licensure surveys of nursing homes?
|
From page 330... ...
: B Survey Agency Personnel and Budget*
|
From page 331... ...
TOTAL 48 6 - 250 44 6 - 246 13. Overall, what percentage of your state agency's total state survey and federal certif ication effort is devoted to: Median Range a .
|
From page 332... ...
Total FTEs 26 1 1 0- 84 9.5 0-84 5.5 0-268 0-439 18.0 0-308 16. In addition to the personnel who carry out survey and inspection of care functions who are listed above, does your agency have personnel whose specif ic duties are to process enforcement actions against facilities or individuals who violate nursing home regulations?
|
From page 333... ...
How many noncertified nursing homes with SNF and/or ICF-like services did your agency license (as of September 1984) that have no federally certif fed beds?
|
From page 334... ...
0.5 .5-6 da 1.0 0.5-6 da 1.0 0.5- 2 da 23. In comparison with current federal Conditions of Participation and standards, are your state's licensing requirements for skilled facilities: a .
|
From page 335... ...
Have your surveyors received "specific" training to better justify enforcement actions when necessary, including 1 ) how to prepare better documentation of evidence; 2 )
|
From page 336... ...
32. How frequently are facilities in your state given the full licensure and certif ication surveys?
|
From page 337... ...
35. Have you changed your licensure and/or certif ication survey procedures in recent years ?
|
From page 338... ...
: 39. In surveying a nursing home for SNF certification, how many standards have to be def icient for the nursing services condition (F123 )
|
From page 339... ...
0938-0395 STATE: 41. A number of agencies in addition to the survey unit collect or receive information about conditions in specific nursing homes.
|
From page 340... ...
( 2 ) At the same visit as the certif ication survey.
|
From page 341... ...
Column B "Recommending Agency, " we are also interested if the survey agency and/or some other agency recommends the legal action.
|
From page 342... ...
Taken Actions 24 1 17 2- 90 _ 19 3 8 8 1-4 12_ __ 7 8 7 4 3 1 3 19/5 15/3 4/2 Suspens ion of all admissions 32 24 6 17 15 1-29 96 26/5 Cons iderat ion of past record in evaluation of cer tificate of need application 25 17 12 7 10 1-36 105 26 Court injunctions against substan dard operation 37 36 1 17 9 1 3 13 19/11 State- initiated relocat ion of res idents f ram substandard homes 36 31 5 21 14 1 8 27 22/8 Reduced Med i caid rates for inferior performance 9 6 12 3 1 10 10 4/2 Conditional or provis tonal licensing 35 34 2 22 14 1-72 268 23/8 Probat ionary license 15 14 6 8 5 1-72 154 9/3 Cr iminal penalties f or pat lent abuse _ 16 14 9 5 1-300 376 13/11_ License revocation 44 41 0 28 15 1-13 59 33/4 Involuntary decert i fication _ 39 1 22 13 1-55 129 26/7_ _ _ _ _ Withho lding of payments 19 8 14 5 3 4-263 272 3/2 Per State: Total sanctions available: Median = 8; Range = 1-14 Number of tvDes of sanctions applied: Median = 2; Range = 1-12 Total number of sanctions applied: Median = 11; Range = 1-457 HCFA-466
|
From page 343... ...
Does your state have a system which rates nursing homes and publicly discloses the ratings?
|
From page 344... ...
The next several questions address the effectiveness of various enforcement efforts. For these questions effectiveness is defined as getting the facilities to comply with nursing home regulations, terminating contracts with facilities that fail to comply, as well as the speed and thoroughness with which the sanction is carried out; e.
|
From page 345... ...
( 8) Can ensure nursing home services of adequate quality, they deleted some unnecessary or unmeasurable provisions.
|
From page 346... ...
65. List what you feel are the f ive most important federal survey and certif ication regulations ( including both the Conditions of Participation and the Subpart S regulations )
|
From page 347... ...
0938-0395 STATE: 67. The current requirement for annual surveys of all federally certified nursing homes should be made more flexible to permit less frequent surveys of facilities with histories of compliance and more than annual surveys of facilities with histories of noncompliance.
|
From page 348... ...
73. Accreditation by JCAH or some other accrediting body should be permitted to stand in place of state surveys for federal certif ication purposes .
|
From page 349... ...
10 76. Should the inspection of care review system be integrated with the process of surveying nursing homes for certification?
|
From page 350... ...
( 2 ) Strongly disagree HCFA-466 )
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.