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To: Center for Healthcare Quality
Protect California’s Fragile Elderly from New Nursing-Home Survey Model
Stop implementation of the new survey model that the Center for Healthcare Quality (CHCQ) is currently phasing in through the California Department of Public Health (CDPH) Licensing and Certification Division. The new model requires nurse surveyors to provide education and training to nursing-home staff on a weekly, if not daily, basis in order to provide greater oversight. This will seriously limit the time available for the old survey model, which involves surveys and complaint investigations designed to ensure compliance with state and federal regulations—without which nursing home operators can not be held accountable for the quality of care they are providing to their residents.
There are app 600 nurse surveyors and 1200 nursing homes in the state of CA. Per the new model, nurse surveyors will be required to “adopt” at least two nursing homes apiece, and to make in-person visits several times a week, sometimes to very remote areas of the state. This will leave no nurses for surveys and complaint investigations. Greater oversight of nursing homes should not be confused with greater patient safety during the pandemic, especially since nurse surveyors are having to go in to facilities without being tested for Covid, or provided with proper PPE. The increased frequency with which nurse surveyors are entering and exiting nursing homes per the new model will only serve to increase the Covid-infection rate, not mitigate it. Greater nursing home presence by surveyors should also not be confused with better care quality in the years beyond: by heavily compromising the time and effort of nurses, the new model will severely limit enforcement of nursing home regulations, the process by which nursing homes are held responsible for patient safety and care quality—and without which care standards will further decline.
There are app 600 nurse surveyors and 1200 nursing homes in the state of CA. Per the new model, nurse surveyors will be required to “adopt” at least two nursing homes apiece, and to make in-person visits several times a week, sometimes to very remote areas of the state. This will leave no nurses for surveys and complaint investigations. Greater oversight of nursing homes should not be confused with greater patient safety during the pandemic, especially since nurse surveyors are having to go in to facilities without being tested for Covid, or provided with proper PPE. The increased frequency with which nurse surveyors are entering and exiting nursing homes per the new model will only serve to increase the Covid-infection rate, not mitigate it. Greater nursing home presence by surveyors should also not be confused with better care quality in the years beyond: by heavily compromising the time and effort of nurses, the new model will severely limit enforcement of nursing home regulations, the process by which nursing homes are held responsible for patient safety and care quality—and without which care standards will further decline.
Why is this important?
This dual consultant/survey model is not new. It is the model that existed throughout the 70s and 80s—a model that resulted in such poor care, it prompted Congress to pass the 1987 Nursing Home Reform Act. This law deemed it unlawful for nurse surveyors to provide facility consults, then turn around and write deficiencies and citations for advice that they, themselves, had given, due to conflict of interest.
Although the CA Health and Safety Code (1417.3) allows nurse surveyors to provide instruction to facilities on occasion, it makes it illegal to provide instruction if it will diminish survey efforts. However, given the degree of facility involvement required of nurses per the new model, survey efforts will clearly be diminished, as there are simply not enough nurses in the state of CA to implement the new survey model and still have time for surveys and complaint investigations.
The new survey model is redundant and represents an inefficient and wasteful use of government spending: nursing homes already have full-time Infection Preventionists on staff, CDPH has infection-control experts that can provide consults without it being a conflict of interest, and the Center for Medicare and Medicaid (CMS) has Quality Improvement Organizations and Quality Improvement Networks that are already providing oversight and education on quality improvement .
The new survey model is in violation of the Nurse Practice Act: the training has not been standardized, the new survey policy was not written by an RN, and Covid-infection control is out of the scope of practice of many nurse surveyors, not all of whom have the Public Health Nurse license required engage in control of communicable disease in the community setting.
The new survey model is in violation of the American Nurses Association Code of Ethics, which obligates nurses not to accept assignments that place patients, or themselves, at risk, or assignments that involve conflicts of interest.
Since the majority of nursing home residents in CA are minorities, the new survey model stands to further harm a patient population that is already underserved by the healthcare system, by further ignoring the healthcare and quality of life needs of CA’s many Latino, African American and Asian nursing-home residents. Implementation of this new model will severely limit the ability of nurse surveyors to hold specific nursing-home administrators accountable for their actions, or hold the nursing-home industry at large for the motivations of a business that is for-profit, and thereby lacking in incentive to provide quality care in the first place.
Although the CA Health and Safety Code (1417.3) allows nurse surveyors to provide instruction to facilities on occasion, it makes it illegal to provide instruction if it will diminish survey efforts. However, given the degree of facility involvement required of nurses per the new model, survey efforts will clearly be diminished, as there are simply not enough nurses in the state of CA to implement the new survey model and still have time for surveys and complaint investigations.
The new survey model is redundant and represents an inefficient and wasteful use of government spending: nursing homes already have full-time Infection Preventionists on staff, CDPH has infection-control experts that can provide consults without it being a conflict of interest, and the Center for Medicare and Medicaid (CMS) has Quality Improvement Organizations and Quality Improvement Networks that are already providing oversight and education on quality improvement .
The new survey model is in violation of the Nurse Practice Act: the training has not been standardized, the new survey policy was not written by an RN, and Covid-infection control is out of the scope of practice of many nurse surveyors, not all of whom have the Public Health Nurse license required engage in control of communicable disease in the community setting.
The new survey model is in violation of the American Nurses Association Code of Ethics, which obligates nurses not to accept assignments that place patients, or themselves, at risk, or assignments that involve conflicts of interest.
Since the majority of nursing home residents in CA are minorities, the new survey model stands to further harm a patient population that is already underserved by the healthcare system, by further ignoring the healthcare and quality of life needs of CA’s many Latino, African American and Asian nursing-home residents. Implementation of this new model will severely limit the ability of nurse surveyors to hold specific nursing-home administrators accountable for their actions, or hold the nursing-home industry at large for the motivations of a business that is for-profit, and thereby lacking in incentive to provide quality care in the first place.
How it will be delivered
E-mail, press conference