Nursing homes face significant challenges in both resident care delivery and regulatory compliance. A patchwork of local, state, and federal regulations governing nursing home operations has only added to the complexities inherent in this sector of the healthcare industry. Nursing home insurance supplements the risk management strategies designed to reduce liability exposures, such as claims of negligence that may lead to an external investigation by governing authorities. When an investigation of operations is triggered, nursing homes must be able to respond in a professional and transparent manner. Here’s how.
Regulatory Investigations: Issues with Oversight
By and large, nursing homes and similar long-term care facilities provide compassionate care for millions of seniors in the United States. Still, news media and elder-care advocacy groups have focused attention on claims of negligence or resident harm; these incidents are few but have dramatically altered the regulatory landscape. Unfortunately, not all regulatory agencies are up to the task when a claim of abuse, neglect, or negligence is presented.
In 2018, the Centers for Medicare and Medicaid Services (CMS) issued a report detailing failures in the oversight of Minnesota nursing homes. The data collected by CMS showed that the Minnesota Department of Health failed to meet deadlines in investigating complaints in six out of every ten cases. In all, the Department missed deadlines for 150 cases – cases that included nursing home residents who were at risk of immediate harm or had been harmed by the actions of others.
Similar situations have occurred in states across the country. Missed deadlines, insufficient oversight, and lack of investigatory staff have put many of America’s seniors at risk from abuse or neglect, including instances of abuse at the hands of fellow residents.
Responding to Regulatory Investigations
As stated in our introduction, nursing home managers and staff owe it to their residents to respond to investigations with professionalism and transparency. In many cases, investigations are centered on individual caregivers, while others focus on the facility as a whole. In either situation, licensure or accreditation may be at stake. Many legal professionals in the healthcare sector recommend that nurses and paraprofessionals do not make any statements to investigators. This recommendation goes against goals of transparency, yet it serves to protect individual caregivers from giving statements that may be used against them. It is also important to note that many nursing home insurance policies do not offer coverage for legal defenses of individual caregivers; these policies are generally designed to protect the facility itself.
For the facility, accurate and thorough recordkeeping is the key to responding to an external investigation. Regulatory authorities will ask the facility to produce a wide range of documentation, including patient records, abuse/negligence claims, and the responses to those claims implemented by the care facility.
To prepare for an investigation or regulatory surveyor visit, nursing homes should incorporate the following strategies:
- Prepare records and notes in advance of the visit.
- Practice with staff members and managers, especially in commonly-reviewed practices like infection control, abuse response protocols, and patient handling practices.
- Train or retrain staff as necessary on patient guidelines and procedures prior to the visit.
- Put risk management practices into place and encourage stakeholders to adhere to them all year long. This helps to create “muscle memory” that can demonstrate to regulators that the facility and its staff are following established practices.
- Explore Quality Assurance and Performance Improvement (QAPI) strategies to identify and mitigate risks before they can cause issues, such as claims of harm or neglect.
- Remain professional throughout the investigatory/survey process. Arguing with regulators rarely satisfies concerns.
- Understand that every investigation can be a learning tool for the facility and its staff.
External investigations can be stressful or even scary for nursing homes. Even the best facilities may find their practices and procedures questioned by regulators. Despite the fears, these investigations can be a valuable educational experience, helping facilities uncover overlooked deficiencies and reducing the liability associated with claims on nursing home insurance plans. The end result is a facility that delivers outstanding patient care while maintaining control over expenses and regulatory issues.
About Caitlin Morgan
Caitlin Morgan specializes in insuring assisted living facilities and nursing homes and can assist you in providing insurance and risk management services for this niche market. Give us a call to learn more about our programs at 877.226.1027.