The survey process for nursing homes should focus on engaging geriatric experts more and recognizing high-performing and innovative facilities rather than assigning blame and focusing on punishments for providers, according to a long-term care task force.
“Current survey processes continue to fly in the face of proven principles of internal motivation for promoting performance, instead assigning individual blame, focusing on punishments and impinging on provider autonomy. It is important that we take a fresh look at the approach and value of the survey process and how it should be improved,” stated the AMDA Survey Taskforce to Facilitate Rethinking of an Upgraded Survey Process.
The group includes geriatrician Michael Wasserman, M.D., AMDA president-elect Karl Steinberg, M.D., past AMDA president Arif Nazir, M.D., Alan Horowitz, Esq., RN, and James Lett II, M.D. Its comments were made in an editorial published in the current issue of JAMDA. The task force was facilitated by AMDA — The Society for Post-Acute and Long-term Care Medicine after noting the intense scrutiny faced by Life Care Center of Kirkland, the first nursing home to suffer a widespread coronavirus outbreak in the U.S.
The facility, which had a five-star rating, received three Immediate Jeopardy deficiencies for its pandemic failures. The experts questioned the accountability measures placed on the highly-rated facility during such an unprecedented emergency.
“Should accountability necessarily equate to punishment, and how often does punishment translate into improved quality in the future? COVID-19 gives us a prime opportunity to pose these questions and develop a framework within which to respond to them,” they said.
Compliance up, but not quality?
The group found that the survey process helps improve regulatory compliance but lacks in ensuring quality of care improvement. A lack of adequate funding and statewide variability also impacts the consistency of surveyors.
Additionally, it found that team morale is negatively impacted by the survey process, and over time the process has evolved to have a heightened focus on adversarial and punitive practices.
The experts called for the process to instead highlight high performers, incorporate constructive feedback and seek collaboration to help other providers improve. They also suggested engaging experts in geriatrics, like increasing medical directors’ role in the quality assessments and problem solving, to assess nursing home performance.
“It is high time that push for a survey process that not only assess performance in a no-blame fashion but also facilitates person-centered care and innovations in care delivery, while continuing to fairly account for deficient practices and negligence. This may be a tall order, but [nursing home] residents and the staff who serve them deserve nothing less,” the group concluded.