While state surveyors vary in what they consider immediate jeopardy for long-term care residents, operators can use government guidelines to work on their quality assurance plans, experts advised Tuesday.

Immediate Jeopardy involves noncompliance that causes, or is likely to cause, serious injury, harm or death to a resident; the “triggers” used to define it can be used as quality assessment tools, said Joan Redden, the vice president of regulatory and consumer affairs at Skilled Healthcare. Redden presented a “Survey and Enforcement Update” with Lyn Bentley, the senior director of regulatory services at the American Health Care Association, at the AHCA annual convention, which wraps up Wednesday in Tampa, FL.

“Using the triggers can help you figure out things,” Redden says. For example, Appendix Q of the Center for Medicare & Medicaid’s State Operations Manual discusses criteria for Immediate Jeopardy that includes failure to protect from psychological harm, failure to protect from undue adverse medications and failure to protect from abuse.

“Be careful with CNAs who are ‘a little rough around the edges,’” Redden warned.

Providers know their residents well, Redden explained, but they can struggle to complete documentation. If a resident, for example, is prone to crying frequently, that should be recorded, lest a surveyor perceive the resident being mistreated by staff.

When Immediate Jeopardy exists, the state can recommend the state Medicaid agency or regional office impose remedies, and assess a per-day or per-instance civil monetary penalty. A per-instance remedy can be $1,000 to $10,000, while per-day can range from $3,050 to $10,000.

AHCA and policymakers have asked for clarifications from CMS on words like “neglect “ and “abuse,” Bently noted. Audience members noted that elopement of residents is a big concern for providers.

“Mercy-do, did we ask for clarification on elopement,” Redden concurred. “In some areas, it’s Immediate Jeopardy.” But while a patient wandering far off-site is always a problem, many facilities in warm climates have residents who just might want to go a few feet outside, she noted. 

When a facility is cited for Immediate Jeopardy, some regions or states allow providers to embed a response in their plan or correction. Even bad news can allow a facility to improve, the presenters said. 

“Conduct a root-cause analysis to determine the reasons for deficient practices,” Redden advised.