You will first have to obtain the government inspection report (survey) then you will have to figure out how to read it. We can help.
One of the most important things you can do to evaluate a nursing home is to review the government inspection reports for it. Obtaining the government inspection report for a nursing home is easy. Just ask us and we will provide it free of charge.
These reports are an important source of objective information that most people never even ask to see. Nursing Home Compare, the five star rating system that is available, uses some of this data, however more meaningful information is included in the actual report. So please fill out our request information form and we will send it to you with no obligation. Read more about how the five-star ratings can be manipulated by the homes.
What is a Survey/Statement of Deficiencies?
All nursing homes that receive any money from Medicare or Medicare are regulated by the federal government. Those regulations include a requirement that every home be inspected to determine if it meets the minimum federal requirements. These government inspections, sometimes called surveys, determine the deficiencies of each nursing home. The inspections are done by each state’s department of health or other agency overseeing nursing homes. The inspector produces a survey, or statement of deficiencies summarizing the violations that were discovered. Each of these violations is detailed in the Statement of Deficiencies. Here is an example of a Statement of Deficiencies.
When you receive the Statement of Deficiencies from us, you will see that it is divided into two columns. On the left hand side are the actual deficiencies found by the inspector. These deficiencies refer to an “F-tag” number. An F-tag is the specific federal regulation that was violated. There are many different F-tags but they fall into four broad categories, Quality of Care, Quality of Life, Staffing and Resident Behavior & Facility Practice.
The inspector then summarizes the evidence they found that the home failed to meet that requirement. In our example, the inspector details four patient charts in which doctor’s orders were not followed. Using numbers instead of patient names, the inspector goes into significant detail about each violation. It is these specifics that can give you real insight into what a home is actually doing.
The right hand column sets forth the home’s plan to correct the deficiencies that were found. Typically these will include re-educating the staff, revising policies and procedures, staffing changes or other ways to address the violations. This section may also include the home’s explanation of violation. If necessary this section may also include the date the home expects the correction will be completed.
What are some of the limitations of the Survey/Statement of Deficiencies?
It is important to realize that this report is only a snapshot of what the inspector found when they conducted the inspection. While the report is one of the best sources of objective data about a specific nursing home, it is extremely limited. A good analogy is to think of a speeding ticket. When you are cited for speeding it means that at that moment the police officer determined that you exceed the maximum speed limit. However, it doesn’t reveal anything about how fast you were going at any other time or in any other place. Of course if you have a lot of speeding tickets or if you were going very far above the limit we may be able to draw certain conclusions about how safe a driver you are. The inspection process is a bit like that.
1 – Surveys are done only about once a year. The required time frame for an inspection is 9-15 months. Unfortunately, nursing homes can decline much more quickly than that. Imagine what would happen to speeding on the highway if people knew that the police would only be checking once a year!
2 – Far too often the nursing homes know when the inspectors are coming. A report from the Office of the Inspector General of Health of the U.S. Department of Health and Human Services concludes that “although all States report that nursing home standard surveys are unannounced, almost all directors and surveyors believe that facilities can roughly predict the survey start date. Most State directors and surveyors say they do not begin standard surveys on the weekend or evenings, but do continue standard surveys into the evening hours and conduct complaint surveys on weekends and evenings.” Of course you would expect a nursing home to be performing its’ best when it knows an inspector is coming. This is like a speeding driver slowing down when he knows the police are just up ahead.
3 – Surveys only look at a small sample of the residents. In our example the inspector only reviewed the charts of 30 residents. So while the report finds “only” four times when the home failed to follow doctors orders it is very important to realize that there were over 300 residents in that home. In order to keep the proper perspective you must divide the number of violations not by the total number of residents in the facility but by the total number that were actually inspected.
4 – Inspections are not done for your parent. The annual inspection does not focus on particular residents. Thus, it tells you nothing about whether the care your parent is receiving complies with the minimal federal requirements. There are short inspections which are done when a complaint is received. These inspections are far more limited in scope than the annual inspections.
5 – Your parents pay for and deserve more than the MINIMUM federal requirements. Since the inspections are designed to only determine if the minimum requirements are being meet, they don’t let us know if our parents are getting the care they really need. Most nursing homes don’t advertise that they provide the minimum level of care required by the federal government. Most residents and their children pay for and expect a higher level of care that is better than the minimum. Unfortunately, the government’s inspection system doesn’t address that issue at all.