Long-Term Care Survey Alert

Nip potential complaints in the bud before they grow into F tags or abuse investigations.

Anything that keeps you a step ahead of complaints, surveyors and plaintiff attorneys pays off in spades. And in that regard, the Quality Indicator Survey's scripted resident and family interviews give you an invaluable improvement opportunity, whether or not your facility is in a state using the QIS.

How so? You know in advance how your customers are going to answer and can remedy negative situations before the survey, says Diane C. Vaughn, RN,C, C-DONA/LTC, LNHA, regional director of Minnesota operations for Pathway Health Services in White Bear Lake, Minn.

More perks: Interviewing residents also helps prepare them for surveyors asking them questions, adds Robin A. Bleier, RN, LHRM, FACDONA, principal of RB Health Partners Inc. in Tarpon Springs, Fla., who uses the interviews in consulting with facilities.

"We have culturally diversified nursing home populations everywhere, but especially in Florida," a QIS state, says Bleier. "So it's good for the residents to understand the questions -- and it's a nice way to solicit information."

Nursing home providers do a lot of tasks for residents, but they don't spend much time sitting down and talking with them, Bleier adds. "Doing the interviews provides a different level of engagement."

As for using the QIS family interviews, Bleier has found occasions where a family person felt much less satisfied with the facility than staff realized. "Unhappy family comments can lead to abuse investigations, if the family person, for example, didn't like how a staff person talked to their resident." Family responses can also raise concerns about staffing sufficiency, dignity issues, misappropriation of the resident's personal property and more, she adds (see the excerpted resident and family interview questions on the next page).

In the QIS, a computerized system identifies residents for interviews who have MDS-driven Cognitive Performance Scale scores of 1-3. But surveyors also ask residents with lower CPS scores simple, conversational questions to see if they can participate. The questions include: "Are you from around here, the area? Tell me a little about yourself."

To assess the quality of care for residents too cognitively impaired for interviews, QIS surveyors conduct a minimum of three interviews with residents' relatives, guardians or friends. The person interviewed has to be intimately involved in the resident's care and know what's going on in the nursing home, says Vaughn.

When using the scripted interviews for residents or family members, ask the questions exactly as they read, instructs Cindy Mason, RN, VP of provider services for Nursing Home Quality LLC in Centennial, Co., which is conducting surveyor training on the QIS.

The QIS surveyor instructions for interviewing residents advises asking the question first and then paraphrasing as needed to make sure the resident understands the question. But the instructions also caution against paraphrasing in a way that changes the intention of the question.

Real-world practice: If Bleier senses the resident may not have answered a question accurately, she will mark it in order to return to it at the end of the interview. At that time, Bleier repeats the question verbatim and then paraphrases it again slightly differently than she did the first time. Bleier also lets the resident know she asked the question already but wants to double check the answer. This approach also helps her confirm the resident's memory status.

Both the resident and family interviews include questions about abuse. The three resident questions in that regard are as follows:

• Have you ever been treated roughly by staff?

• Has staff yelled or been rude to you?

• Do you feel afraid because of the way you or some other resident is treated?

Abuse alert: If the resident or his family answers yes to the abuse questions, investigate the situation as you would any allegation.

When providers use the QIS tools for QA, they are still held accountable for following state and federal abuse reporting requirements, Mason cautions.

Resource: To review the entire resident interview and related resident observations, go to www.uchsc.edu/hcpr/qis_manual/Tab5/CMS-20050%20Resident%20Interview%20and%20Observation.pdf. The family interview questions are available at www.uchsc.edu/hcpr/qis_manual/Tab5/CMS-20049%20Family%20Interview.pdf.