You need to keep in mind and perhaps adopt a new approach to your surveys and other actions with regulators. In many states, we're seeing this trend where the deficiencies are being written differently than they used to be. Read this expert guidance provided by our expert in a long term care conference to know more.
And that a lot more investigation is being done during the survey process. More interviews of staff are being done. And by interviews, it is meant more than just surveyor observing a treatment and asking the nurse a couple of mentions. It means sitting down and requesting the DON or the ADON or another staff member sits down with the surveyor during the survey process. And the surveyor may have a chart, a patient’s chart in front of him or her and asking very specific questions.
In the past, many facilities have viewed the surveys as kind of a necessarily evil. You have to get through it. And you have to do it as per the long term care rules. But that it's business as usual while the survey is going on meaning they shouldn't stand on their head and change what you normally do. They should follow their normal course of conduct during the day and take care of their resident.
But that approach in the past unfortunately has led to situations where people have their guard down a little bit and may answer a question casually or off-the-cuff because they're in the middle of something else. They're in the middle of giving meds. They're in the middle of providing wound care. They might be assisting with feeding a resident. They're in the middle of something else as surveyors asking them a question that might be a very specific factual question. And they answer off-the-cuff and say, “Well, I think it could be X or I think it could be Y.”
And then the surveyor is taking that response as gospel. And it's findings its way into a survey report as some of the support for the deficiency. We've had numerous examples in connection with matters that have gone through the informal dispute resolution process where once the staff member sees the quote that’s been attributed to him or her and the survey in black and white, they're very troubled and say, “Well, that's not what I said. That's not what I intended. I don’t even remember that discussion” because, you know, keep in mind that sometimes survey reports can be issued, you know, well after the survey. It's not the ideal process but some states are behind in their processes.
So from the staff member’s point of view, they've moved on. They might have even forgotten the conversation but then they see the 2567 and say, “Wow! I don’t remember that conversation or that's never what I have intended.” So unfortunately, it's kind of a reality of doing business these days that staff members need to be much more weary about their interactions with regulators of any stripe, from any of the regulatory agencies.
And give them enough long term care training so that they don’t just answer questions off-the-cuff or on the fly and not fully understand where the regulator is coming from before they respond to a question. The mantra should be going back to the old detective and cop shows, “Anything you say can and will be used against you in the court of law.” You hate to really look at it as an adversarial process. But unfortunately that tone, that adversarial tone is characterizing many surveys and many regulator interactions these days.
Our expert pointed out in the long term medicare conference that employees need to be concerned when they're having exchanges with regulators that they don’t make incriminating statement. And incriminating can be from a criminal perspective which is how most people normally think of that term.
But it can be that kind of off-the-cuff or casual comment or even one that's not casual and was that staff member’s reality. But that nonetheless is used to justify a broader deficiency. So employees that is absolutely an important goal is to train employees, to educate employees about their interactions. And I mean that at all levels of the facility, from your administration all the way to your laundry, maintenance, facilities, dietary.
Now, the intensity of the information may be a little bit different depending on the level of responsibility in the facility. But any staff member is fair game for any surveyor when they come in to the building or any other regulator if they have the authority to be on premises and talking to staff members.
So it's not just something that you want to focus on for a few people in the facility. But it's something that you want to make sure that all the employees of a facility understand and should have long term care training for it. At least understand the regulatory context in which you all operate and the importance of understanding who they're talking to and what the issue is when the surveyor or other regulator comes in to have a chat with them.
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