The results of a new study from the Long Term Care Community Coalition, “Safeguarding Residents & Program Integrity in New York State Nursing Homes: An Assessment of Government Agency Performance,” find that nursing home survey results may not be as accurate as they could be. New York has the largest number of nursing home residents in the country, but seemingly some of the lowest enforcement levels. The LTCCC completed an assessment of the NYSDOH performance in several areas, including the ways in which the SA identified deficient practices versus the entire country. The findings of this report will most likely not go unnoticed by the NYSDOH since they are not necessarily flattering, which could mean an increase in survey activity in some areas of the report. Let’s take a look at the results and some things to consider.
- During survey, NYSDOH ranks third lowest in per capita citations, which is approximately one-third of the national average of citations given per state. The two states that provided lower numbers of citations were Rhode Island and New Hampshire, where there are significantly fewer nursing homes.
- Citations given are mostly cited at a scope/severity of no actual harm (D-F) – 96.6%. This is consistent with reviews CMSCG has completed of various states as well as on a national scale. In New York, harm and immediate jeopardy citations for 2013-2014 were given less frequently than from 2011-2013.
- New York nursing homes also receive fewer monetary fines than other states. This correlates with the lower numbers of citations, particularly actual harm and IJ citations.
The study also reviewed three key initiatives in the nursing home industry and how New York fares against the rest of the nation:
- Antipsychotic drug use in nursing homes – The Partnership to Improve Dementia Care in Nursing Homes provided an update recently which shows that New York has reduced the prevalence of antipsychotic drug use in its nursing homes by 19%, which is in line with the national prevalence of 19.1% (as of Q4 2014). The LTCCC study found that citations for F-329 are low across the country, but recognize that F-329 encompasses all types of unnecessary drugs, not just antipsychotics, so the findings here are not specific to this measure.
- Pressure ulcers – Another area the LTCCC study looks at is citations at F-314, which relates to pressure ulcers. Nationally, as well as in New York, citations under this tag are not commonly given. While this means that surveyors may need to focus more on this area, NY has implemented initiatives like the Gold STAMP Program to reduce the incidence of pressure ulcers and facilities should continue to focus efforts on this areas.
- Staffing levels – The study notes that New York has some of the lowest staffing levels in the nation – 13th lowest. Citations for inadequate staffing are also low, which is problematic in all states. We looked at F-353 staffing citations for a Long Term Living webinar recently and found that these citations are on the rise in the past few years, and with the focus on staffing levels, CMSCG anticipates these deficiencies will go up in volume, as well as S/S. Facilities will also be impacted by the Payroll-Based Journal that is going into effect in 2016 for all nursing homes, so staffing levels will have to be addressed.
These are two charts that CMSCG developed for Long Term Living’s Five Star Rating webinar on staffing. You can see that these citations are on the rise in both volume and scope/severity, but 2015 may see a bigger jump yet.