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Providers blast surveys.

CMS chief calls the system "nutty"

THE NEW YORK ASSOCIATION OF HOMES & Services for the Aging (NYAHSA) has issued a report claiming that the survey process intended to protect the state's nursing home residents instead threatens their safety by forcing providers to focus on bureaucratic minutiae instead of resident care.

NYAHSA's report, entitled Bad Medicine: How Government Oversight of Nursing Homes is Threatening Quality care, alleges that the survey process is riddled with inconsistencies, surveyor subjectivity, and trivia; process- and paperwork-oriented, rather than outcome-based; and contradictory to federal statutory and regulatory intent. NYAHSA also criticizes the system for failing to recognize or improve quality of care and for failing to provide adequate information to consumers and providers.

"The people we serve need us to focus all of our energies on providing high-quality care, not on the trivia that measures only regulatory compliance and often has nothing to do with care," said NYAHSA President Carl S. Young in a statement.

On a national level, the survey process has drawn criticism from CMS Administrator Tom Scully, who insists that the current system is "nutty" and that CMS (formerly HCFA) should spend its survey budget more wisely within statutory requirements. Scully has stated that "Nursing homes that consistently have problems ... should have an inspector in there every three months, not every 12 months." Conversely, he recommends that facilities with good records be surveyed every two years.

Regulators and advocates fire back

Robert Kenney, a spokesman for the New York State Department of Health (DOH) stands by the current regulatory system. "If [NYAHSA] spent as much time ensuring that their facilities are compliant and safe within state and federal regulations as they do carping and complaining about the survey process and trying to shield themselves from scrutiny," says Kenney, "the elderly and vulnerable in New York's nursing facilities would receive quality care."

Cynthia Rudder, director of Nursing Home Community Coalition of New York State, also takes issue with NYAHSA.

"We have identified problems in nursing homes that we, families and residents, had seen for many years, that we felt were not identified by the surveyors: bedsores, misuse of restraints, issues with malnutrition and dehydration," she says. "Finally, the state is coming around and doing what it should do. And the facilities are very angry." Rudder concurs with NYAHSA on one point: that the survey process should be more uniform and consistent.

Recommendations for reform

Larry Minnix, president and CEO of the American Association of Homes & Services for the Aging, comments that the regulatory system has created a "pressure cooker of confusion and mistrust." He adds that most of New York's providers are people of integrity who work hard to meet their residents' needs.

"I find it to be a gross overstatement on anybody's part to say that our [New York] members are howling because the system is finally doing what it's supposed to and punishing nursing homes," says Minnix. "I think that is over-reactive consumerism that is unfair."

NYAHSA's recommendations for reform include developing a collaborative approach by allowing surveyors and caregivers to work together, enabling surveyors to provide technical assistance, and promoting the exchange of information on innovative and best practices. The NYAHSA report can be downloaded at [less than][greater than].

The association also calls for the DOH to stop issuing monthly press releases of survey results, claiming that they often contain incorrect or misleading information and generate negative media coverage. Kenney says the DOH will continue to disseminate the reports.
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Publication:Contemporary Long Term Care
Date:Oct 1, 2001
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