Change the nursing home survey process

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Elizabeth Leis Newman
Elizabeth Leis Newman

Slowly but surely, quality is improving in many nursing homes. Credit the push to reduce antipsychotics, the embrace of culture change or, if you really want, pressure from the federal government. Whichever way you look at it, it's time to re-examine why the survey and certification process is the same for all skilled nursing facilities.

That's why LeadingAge is first pushing for the Institute of Medicine to look at a new survey and certification process in a study, then to use that research to push for a bill in Congress by 2018. If it all works as hoped, it would mean high-performing nursing homes wouldn't have the fire of the Centers for Medicare & Medicaid Services dragon breathing down their necks every nine to 15 months.

Of course, if you're not doing well, as LeadingAge president and CEO Larry Minnix points out, “someone could be in every month.”

“CMS has ways to close down bad providers, but it's hard to do,” he noted in a chat we had during the LeadingAge PEAK Leadership Summit this week in Washington. “Nursing home regulations are built around the idea that everyone gets the same treatment.”

To be clear, the organization and Minnix want to see weaker facilities turn around rather than close, but he's even more interested in making sure facilities with consistent high quality be allowed to use their time and resources more wisely. Some facilities go years without deficiencies, yet are treated the same as those with major problems. From a federal government budget perspective, it also makes more sense to spend money to figure out what needs to be changed in an under-performing home than to keep checking off boxes in a high-quality facility.

“You can turn around a bad nursing home in six months; good care takes a few years,” he says. “We end up punishing the wrong people.”

The plan to change the survey process is only one of many goals in the organization's four-year plan, but it's one of the most understandable and measurable. The counterpoint will be consumer groups saying everyone should have more surveys, but that's an idea where there's neither the money nor the will to bring it to fruition.

A new survey process that fixates on poor providers and spends less time on high-quality providers should be budget-neutral. Hopefully it will be embraced, when the time comes, by a bi-partisan group of legislators.

After all, even the most conservative of legislators would concede the nursing home survey process is designed – and needed ‑ to close down the House of Horrors facilities out there. But what would really bring a smile to their faces is the idea of government leaving alone facilities that are consistently doing a good job.

Elizabeth Newman is Senior Editor at McKnight's and fresh off attending the LeadingAge PEAK summit. Follow her @TigerELN.


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Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Marty Stempniak.