The Omnibus Budget Reconciliation Act (OBRA) is also known as the Nursing Home Reform Act of 1987. OBRA is interpreted with the U.S. Code of Federal Regulations (42 CFR Part 483) and requires that nursing homes have routine inspections completed by the appropriate state department of health. In Indiana, the Indiana State Department of Health (ISDOH) oversees the operation of nursing facilities and may enter nursing homes to assess their compliance with such regulations at any time and complete what is known as a “state survey.” Under OBRA, it is required that these visits go unannounced. Most facilities have at least an annual survey, but many have surveys more often if there are deficiencies or complaints from residents, nursing home staff, family members, or the community. This is known as a “complaint survey.
The annual survey usually lasts 4-5 days, but may be conducted longer if significant problems are noted. During a complaint survey, usually one specific resident and his or her care are targeted, and the survey is much shorter. If surveyors find deficiencies in standard of care while conducting a complaint survey, then a longer survey may be completed.
When ISDOH surveyors enter the nursing home, the director of nursing or his/her designee will make initial rounds with them. At that time, the surveyors will assess the nursing home environment and general care of residents. The nursing staff must respond to the surveyor’s questions and requests for information and records.
Based on information that has been electronically transmitted from the minimum data set resident assessments, surveyors will have a list of specific residents they want to assess before they even enter the nursing home. If they see additional care issues while at the nursing home, they will assess these residents and their care records as well. Among the surveyor’s activities while completing the nursing home survey is watching nursing staff pass medications, complete treatments, and serve a meal.
A closing meeting with nursing home staff is usually completed each day of the survey so that surveyors can report on their findings of the day and request additional information as needed. On the last day of the survey during the exit interview, the surveyors will give a verbal report of their findings. A written report of the survey is then sent to the nursing home, and if there are deficiencies putting the nursing home out of compliance with state and federal regulations, the director of nursing and other members of the nursing staff may participate in formulating a plan of correction to submit to the state. If the plan of correction is accepted, then the state can place the nursing home back into full compliance with regulations. Additional site visits are often made to ensure the nursing home is complying with their plan of correction. If there is continued lack of compliance, additional site visits and stricter penalties may be enforced.
Each deficiency is analyzed based on the scope of the deficiency, meaning whether the deficiency constitutes a pattern of activity or whether it is an isolated or sporadic occurrence. If the scope of the deficiency is deemed severe, it represents a threat to the safety and welfare of residents and the nursing home will suffer major penalties.
Some facilities are heavily fined for their deficiencies, resulting in higher insurance premiums. Due to the heavy fines and the expense of nursing home insurance, some facilities choose to go “bare” and not have insurance at all, putting the welfare and lives of its residents at risk. Another result of a poor survey includes the inability to teach the certified nursing assistant class, which can decrease the availability of trained staff to care for residents.
Questions to ask the nursing home:
- How many times this year has the ISDOH conducted a survey in this nursing home (complaint, routine and follow up surveys)?
- Has this nursing home ever been prohibited by the ISDOH from teaching the certified nursing assistant course?
- Does this nursing home carry malpractice insurance?