Long-Term Care Facility Surveys: What You REALLY Need to Know
By Brenda Lyle, CMC
There has recently been a series of newspaper articles in the Orlando Sentinel on the redaction of information contained in the surveys done on assisted living facilities and nursing homes in the state of Florida. Although drawing attention to the redaction of information is important it isn’t the most important point of the news stories. Most readers don’t even know what a survey is and they certainly don’t know how to interpret one. Letting the public know that they exist has served a broader purpose than reporting on the actual topic of the story. Here’s what you really need to know about surveys in long-term care facilities.
The Agency for Healthcare Administration (AHCA) does inspections on nursing homes, assisted living, adult family care homes, home health agencies, nurse registries, adult day care centers, home medical equipment companies, and intermediate care facilities on an annual, biennial, or as needed basis for complaints. Those inspections are public record and can be found on the AHCA website (www.floridahealthfinder.gov) Recent changes in policy by AHCA has redacted certain information to protect the identity of the patient. Some feel that the redactions have removed too much information and are limiting the consumers’ insight into the report. The purpose of these inspections is to ensure that the facility/business is in compliance with AHCA’s rules and regulations as they pertain to that entity. Violations are listed a “deficiencies” and are cited with the rule or regulation violation. AHCA is also permitted to determine the severity of the violation. These are listed as Class I-IV and there may be a fine associated with severe violations.
As a care manager, I frequently review the current surveys of nursing homes, home health agencies and assisted living communities. When I arrive at the inspection page, I can tell if the survey was poor before I ever read the report. I notice two things: 1) If there is a fine listed on the home page of the AHCA page for the facility. If there is a history of fines for that community, we have bigger problems. 2) When I click on the “inspection reports” icon and there are numerous “complaint” surveys.
When you delve into these reports you will find that often many of the pages are deficiencies in the documentation of staff training. AHCA has regulations and rules that define required staff training and the documentation of that training in a timely manner. Of most concern are Class I violations that “represent serious and immediate risk or harm to patients or residents.” Another key piece of information is the “owner since” listing. That tells you who owned the facility when the deficiency was tagged and if the ownership has changed. An easy way to compare one or more facility is to go onto www.floridahealthfinder.gov , choose “Compare” then “Assisted Living Facilities”. On the next page choose the large box that says “Compare Assisted Living Facilities”. You will then be prompted to the search page so that you can customize the list according to what you are looking for. When you choose a region, or county, you will get a full report on the really important things you want to be looking for when you are searching for an ALF. You will find how many complaints, survey deficiencies, and fines an ALF has paid. Now, how good this information is is largely dependent upon AHCA updating information in their database in a timely manner. If you click on an individual ALF you will still get a snapshot of at least the number of fines they have had in the past 5years or more. Ultimately, the number of deficiencies is the key indicator of the quality of the care within the ALF. You can do the same thing with nursing homes both at this website and at Medicare.gov. The difference is that you will see a star rating system, like you would see for a hotel, rather than a deficiency report.
The Sentinel articles are important in that they bring the consumer awareness that these inspection reports exist. But this is a case of not seeing the “forest for the trees.” Don’t get caught up in the details. You can learn what you need to know about the ALF inspections without digging into the details. The ultimate test of whether or not an ALF or nursing home is a good fit for your family is still the same- GO VISIT!! Go in the morning, in the evening and again on the weekend. If you like what you see, hear, smell and your gut tells you, then go with it. Don’t use just the AHCA inspections as your sole source of decision-making but as another tool in your “educated decision” toolbox.