Long-Term Care Survey Alert

Find out how CMS would cite 3 common scenarios.

Put on your surveyor's cap and determine the severity level for the following situations involving negative psychosocial outcomes related to a deficient practice.

Scenario No. 1: A resident becomes combative during a shower. A resident tells the CNAs she doesn't want a shower, but they insist on taking her to the shower anyway. The resident continues to verbally resist the CNAs' efforts to bathe her and at one point says she doesn't like the CNAs "looking at her tail." Finally, the resident bites one of the CNAs. Even so, the CNAs continue to bathe the resident until the resident's shower chair tips over backwards in the shower, resulting in what looks like a serious fall.

Scenario No. 2: A resident has persistent adjustment issues after admission to the facility. During the survey, the resident repeatedly bangs on the locked door to the unit, tearfully saying she wants to go home. She also says "this is no life for me" and says she's someone who is "full of energy" and want to get out out and do things. The staff tells surveyors that the resident always acts like this.

Scenario No. 3: Surveyors see residents with dementia sitting around all day with nothing to do. The residents aren't actively complaining about being bored. The survey team has sampled many residents, finding that many either have no care plan for activities or the care plan hasn't been implemented. Surveyors could not interview the residents in question because of the residents' dementia.

To find out how the Centers for Medicare & Medicaid Services' survey agency officials presenting in a recent surveyor training Webcast say they'd cite the above scenarios--and their suggested alternatives to handling the situations therapeutically--see the July 2006 Long-Term Care Survey Alert.