Dr. El

The treatment team sat around the table calculating the approximate arrival date of the surveyors based on rumors, past years’ experience, and sightings from colleagues at other facilities in the city. 

“If they approach you,” the director of nursing advised, “try not to say too much.”

The young social worker remarked, “If I see them coming, I’ll run the other way!”

“That’ll work,” I said. “Unless we all do it.”

The above scene typifies the views I’ve observed of nursing home staff towards surveyors — the tracking of the enemy, the red-eyed anxiety of overworked staff, the fear of an inadvertent gaffe. 

What if, instead of a system based on the notion that nursing homes should be punished for deliberately flouting the rules, the underlying belief was that facilities were trying to do their best? What if surveyors were viewed not as adversaries, but as essential team members who share the common goal of excellent care?

In LTC task force pushes for ‘complete redesign’ of nursing home survey process that places less blame on providers, McKnight’s Long-Term Care News author Danielle Brown reports on the JAMDA editorial based on the findings of the AMDA Survey Taskforce to Facilitate Rethinking of an Upgraded Survey Process. 

The group of medical experts contend that while the survey process improves regulatory compliance, it doesn’t ensure quality of care. It also negatively impacts staff morale (something we should be paying more attention to than ever, given the demoralizing effect of COVID-19). 

The AMDA task force calls for consistent funding and training of surveyors, a more collaborative and educational approach, increased use of geriatric experts such as medical directors, and identification and sharing of best practices.

I couldn’t agree more. 

The current system reminds me of the psychological theory of displacement, where the recipient of a negative emotion redirects it towards a less threatening target. It’s the old story of the boss who yells at the man, who goes home and screams at his wife who shouts at the kid who kicks the dog.

In LTC, the surveyors penalize the administrators who rant at their department heads who write up their staff members who belittle the residents. 

I envision a new, improved survey system based on the assumption of goodwill and a philosophy of working with facilities to improve care. Nursing homes found to have deficiencies in, say, infection control, would be directed to educational resources on a user-friendly website, offered free or low-cost seminars in how to correct these deficiencies, and perhaps paired with an experienced guide from CMS or from a facility that overcame similar problems. (I’m brainstorming here.)

Moreover, surveyors who become aware of similar problems at other nursing homes would be empowered to share and act upon that information. For example, if multiple homes were found not to be using adequate PPE, that information would trigger an investigation into why this was occurring in the local area or the larger LTC system. Perhaps it would become clear that there was a supply chain obstacle, or trouble with distribution, or that price-gouging made it difficult to obtain an adequate supply of PPE.

I’d also point out that an examination of systems problems should make use of psychological expertise. There’s a whole field of industrial and organizational (I/O) psychologists that the American Psychological Association describes as focused on “the behavior of employees in the workplace. They apply psychological principles and research methods to improve the overall work environment, including performance, communication, professionål satisfaction and safety.” If we’re going to be reinventing our survey process and our industry after the ravages of the pandemic, let’s draw on this body of knowledge. 

As the AMDA experts note, an educational, collaborative approach to surveys would be more likely to improve care quality and morale than current procedures. Such a change might also shift the punitive focus from the vast majority of long-term care facilities that are attempting to maintain sustainable businesses of caring under difficult circumstances to the companies that are trying to siphon off as much money as possible from a short-term investment prior to declaring bankruptcy.

Eleanor Feldman Barbera, Ph.D., author of The Savvy Resident’s Guide, is an Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is a Bronze Medalist for Best Blog in the American Society of Business Publication Editors national competition andGold Medalist in the Blog-How To/Tips/Service category in their Midwest Regional competition. To contact her for speaking engagements and/or content writing, visit her at EleanorFeldmanBarbera.com.