Survey Guidelines

Skilled Nursing News had an article on updated long-term care facility standards to prevent future cases of neglect that are far too common. These new regulations apply when facility inspections or “surveys” take place.

Such surveys may be difficult for facilities to prepare for, as the standards are quite detailed with over 900 pages long. However, facilities can prepare for this by knowing when their next survey is expected to take place (in order to prepare in a timely manor), focusing on areas they already know to be weak (some common weak spots include mental health diagnoses, opioid use, health equity, etc), and by using CMS tools to better understands what inspectors will be looking for.

Some important areas that facility management should focus on include:

1. Admissions, transfers, and discharges: Facilities cannot require a family member to guarantee payment and must update their admission agreements. Further, discharge decisions must involve the entirety of the patient’s care team, be safe, and offer strong evidence for why the resident is being discharged.
2. Mental Health diagnoses: Facilities can not longer rely on old medical records. Instead, they must confirm all diagnosis with proper documentation or re-evaluate patients upon their arrival. This is important, as a misdiagnosis can now hurt a facility’s rating for months at a time. Faculties should be especially careful in misdiagnosing schizophrenia.
3. Opioid use: Residents must be made aware when they are consuming opioids and actively agree to any changes in dosage. Facilities should be careful to avoid addictions in residents.
4. Teamwork and accountability: Tasks should be properly divided among staff and everyone should be given deadlines. Training should also be an ongoing operation that evolves with time—not simply a one-time event.
5. Medical directors: The head physician of each facility must ensure that staff are following the rules.
6. Health equity: Facilities must ensure that they are treating each resident fairly regardless of their background, payment pay, race, social class, or any other basis.
7. Accurate data collection (MDS forms): Facilities must track residents’ physical and mental health status carefully and by using standardized forms. They should be aware that scoring has changed from Section G to Section GG, which requires more emphasis on what residents are usually able to do every day.
8. Infection control and COVID: Facilities should use stronger protective measures if residents carry drug-resistant infections. They must also education and offer vaccines to residents and staff, with clear

Inspectors now require proof and up-to-date documentation for almost everything—especially mental health conditions. If facilities fail to meet these standards, they should expect to receive a significant drop in their quality ratings, which may decrease their funding and hurt their reputation. Remember that the above list is merely a summary, and a thorough read-through of the new standards would be best to understand their full significance.

While these standards may seem like common curtsy, it’s extremely fortunate that government agencies are now requiring these standards to prevent further abuse from taking place.