IN BOX.

Another black eye for the survey process?

Who could argue in favor of a provider whose facility has a history of substandard-care deficiencies? (See "Surviving the survey process ... or hiding behind it?" April 2001 CLTC, page 16.) Besides proving the administrator was no longer able to control critical aspects of his facility's operation, it is yet another sad example that proves the survey process needs to be trashed.

When a surveyor finds too many bedsores and shredded newspapers being used instead of disposable diapers, something is drastically wrong. The surveyors who inspected Ansley Pavilion knew there were problems. However, because the survey is more about the process than the outcome, providers can comply like a yo-yo, offering meaningless plans of corrections for serious problems.

A major flaw in the process is that surveyors cry wolf. The same process in place for serious deficiencies is also used for minor ones. Surveyors spend as much regulatory time on a burnt out light bulb as they do an avoidable bedsore. Sure there is "scope and severity," but it's like getting a speeding ticket for going one mile over the limit. Police won't bother issuing that ticket, but our survey process demands it and many surveyors enjoy it!

What's missing is common sense and trust. The Feds don't trust the surveyors any more than providers. They survey the surveyors! And when something goes wrong, acres of trees will die to make the paper sent out mandating more and better regulation to prevent the problem from happening again. But, just as there are laws against shooting someone, there are already rules which prevent a facility from using newspaper as an incontinence product.

The survey process needs to be overhauled. Providers should not be able to come in and out of compliance with the seasons. Just as we issue discipline to our staff, there should be a reasonable, progressive policy in place to address provider deficiencies. The sanction should be in line with the infraction. With rough guidelines, surveyors should be allowed to inspect a facility as they see fit. They should dig as deep or as shallow as circumstances warrant and spend as much or as little time as they deem necessary.

Unfortunately, until we decide to rethink our survey process there is little to prevent Ansley Pavilion situations from happening again. The survey process may have identified problems but when confronted with the realities of continued non-compliance, those responsible for implementing further sanctions found it was always easier to put Ansley Pavilion back into compliance than follow through with decertification.

John Jay Stone

Administrator, Spring Meadows Extended Care Facility in Holland, Ohio 

Wanderers don't always walk

I recently read your article, "Out for a walk," in the September 2000 issue (page 40). I found it very helpful and insightful. After working on a skilled dementia unit of a retirement community, I can relate to the need for dementia residents to keep busy. I liked the tips about spending time to figure out what drives the need for the resident to wander such as to let the cat in or to get to a car. I have used these techniques in the past and found them successful as long as I go with them into their "reality."

I am, however, disappointed that most of the interventions cited assume the resident is in an early or moderate stage of dementia and, therefore, capable of walking and wandering or keeping busy with a task such as folding towels or sweeping floors. My experience is mostly with severe dementia residents, many of whom have lost the ability to walk or even stand well balanced, but who do not remember this and nevertheless still feel the need to go somewhere.

This becomes a safety issue as well. They are the most bored, because their inability to be mobile leaves them in the same place for long periods of time. An article addressing the needs of these residents is a must. How do we quell their wanderlust?

Bethann J Greenawalt, RN, BSN 

MSN student in Nursing and Healthcare Administration, University of Pennsylvania 

A shared experience touches readers

People who read about my experience as a long term care consumer (see "Taking it 'personally'," August 2000 CLTC, page 19) have contacted me and said they found it moving and on target. One of my colleagues stated that she would be using it in her orientation class. It's been very complimentary, but more importantly, I'm glad it touched people in a positive manner.

Charles & Weiden

Executive Director, Jewish Senior Services of Toledo in Sylvania, Ohio