Health Care thoughts: Regulatory Weirdness
by Tom aka Rusty Rustbelt
Health Care : Regulatory Weirdness
Nursing homes (SNFs and NFs) are very highly regulated, more regulated than hospitals.
Included in the regulatory regime is a minimum of one survey per year by the state, with additional state and federal surveys possible.
I’ve read hundreds of the voluminous survey reports and am occasionally asked to review a report.
The survey I read recently was quite good, not surprising being a new building with an excellent nursing staff. There were the usual nit-picky citations, and two major cites.
The first major cite was for very minor inconsistencies among nurses notes, QA reports, incident reports and infection control tracking. Emphasis on the “minor.” Dumb.
The second was on the disaster plan. The facility does not have the typical long halls but has a pod structure built around a central area, a very nice building. In the case of wind or a tornado warning each pod would move residents to the safest place in the pod.
The surveyors want everyone moved to the central area, where there are 8 foot high windows facing west overlooking the patio, a perfect source of glass shard shrapnel.
The home has two choices: agree with the surveyors or spend time and money appealing. Agreement is usually the best course of action.
The nurses already have decided – when the tornado siren sounds they will put the residents in the safest place, not the state mandated danger zone.
Never assume regulatory activity really accomplishes its goal.
Tom aka Rusty Rustbelt
You’re certainly on target in this regard. I worked more than 20 years for NYS OMRDD in institutional care. The regulations were bigger than Webster’s Unabridged, including both medical aspects of care and “educational” services. Surveys were conducted by state, city and federal examiners independent of each other. Operations were nearly always in “pre-survey mode.” And you could never fully please the surveyers. Unfortunately if you pay people to look for inadequacies you can be certain that those people will find things to be inadequate. But there is no good alternative. The work is so difficult that without the over the shoulder approach things would quickly fall to pieces.
PS: It was a state agency and the pay was crap but the fringe was decent. No one did it because they were looking to get rich. They were all there either to work for pay or to do a good deed for the less fortunate. Some did it for both reasons. Burn out was a serious problem .
Yeah, Jack–Tell me about the burn out and the work being it’s own reward. It better be. All you get for doing a good job is more work. NancyO
Rusty–Your comments on health care are very helpful. I have learned a lot from your pieces and appreciate the effort you make to inform us. Nancy Ortiz
You are welcome.
My all time favorite nursing home survey citation:
“Facility kitchen staff was thawing chicken outside the freezer.”
Honest to God.
STR, Now, that is a funny damn thing for anybody to say. Bring on the LOL kittehs. NO