DOH Updates LeadingAge NY on Key Nursing Home Issues
On Wed., March 15th, LeadingAge NY met with the Department of Health (DOH) to discuss a wide range of nursing home issues. The meeting was part of an ongoing quarterly series of meetings to discuss policy and guidance issues and their impact on members. The following issues were discussed:
Survey: Survey data from 2020 to 2023 was shared. The top 10 statewide citations may have changed in order, but many of the same deficiencies were cited from one year to the next. One particular area of concern was the continued issues identified resulting in the citation of Accidents (F689), cited in the top three for the last three years. The concerns expressed were in terms of supervision of residents and staff competency, as well as knowledge of the care plans. Abuse was also a significant concern. F609 (Reporting Abuse) and F610 (Investigating Abuse) were among the deficiencies frequently identified. Once abuse has been alleged, it must be investigated immediately, and any accused must be removed from resident contact until the investigation is completed. DOH was also concerned that some providers are still unaware of the requirement to report an allegation of abuse immediately, not to exceed two hours.
Informal Dispute Resolution (IDR): From 2020 to 2022, the number of requests for IDRs doubled, and there were a number of instances where providers were successful in having the scope and severity of the deficiency reduced or in some instances having the deficiency overturned completely. DOH encourages facilities to utilize the IDR process when they feel that the citation is in error.
Immediate Jeopardy (IJ): The number of IJs cited so far this year is five, but over the past two years, the number has been increasing. In 2021, there were 25 IJs cited, and that number jumped to 38 in 2022. Several situations seem to be frequently identified in IJ citations – for example, the inability to correctly identify the resident's advance directives, resulting in CPR not taking place when the resident had indicated they wanted to be resuscitated or CPR performed when the resident was a Do Not Resuscitate (DNR). DOH stressed the need to educate staff on where identifiers are located and that identifiers should be consistent wherever they are located in the facility. Advance directives should be reviewed regularly. Another area where IJs were frequently cited was in accidents, specifically elopement, where staff failed to look for the resident after an alarm was activated or were unaware of elopement risk even though the resident had been assessed and identified as high-risk. There were IJs cited as a result of sexual abuse and for unsafe smoking as well.
TNA to CNA Transition: Aug. 5th is the end date for temporary nurse aides (TNAs) hired during the COVID-19 pandemic to be tested and obtain certification as a certified nurse aide (CNA). After that date, an individual seeking to become a CNA can only be trained through an approved Nurse Aide Training Program (NATP). To date, 437 individuals need to be tested or retested. 150 of those individuals have not been tested at all, and 92 have yet to apply for testing. Questions on the training should go to NATP@health.ny.gov.
Waiver and Equivalency Guidelines: If a Life Safety Code (LSC) citation or health survey citation for not meeting a regulatory requirement is identified, every effort should be made to correct the deficiency. If the facility is not able to come into compliance for a specific tag, it may use an alternative system to come into compliance. If it cannot meet code requirements due to unavoidable circumstances, within 90 days, or meet the equivalency, it can request a waiver. There is much confusion in this area on both the federal and state waiver process. DOH plans to issue a Dear Administrator Letter (DAL) in April and provide training to providers on the process. A new waiver request form for structural infeasibility or hardship pertaining to deficiencies in physical plant and new guidelines for waiver and equivalency submissions have been posted to the certificate of need section of the DOH website.
Money Follows the Person (MFP): A brief presentation on this program was provided. The slide presentation, MFP 2019, MFP 2020, and Minimum Data Set (MDS) Section Q guide were shared.
Contact: Elliott Frost, efrost@leadingageny.org, 518-441-8761