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OCR for page 407
Index
A
Access to residents and records, 31,
173-174. 180
Accreditation, 1, 185
Activities of daily living
assistance in, 8, 9, 47, 48
distribution of dependencies in, 372
Administration
proposed Condition of Participation
on, 29-31, 81, 88-89
of regulations, 6
Administration on Aging, 42, 174, 185
Admissions
authority to ban, 164
suspension of, 165- 166
Alzheimer's disease, 58, 92, 197
American Academy of Family Practice, 4
American National Standards Institute,
Standard 55- 1981, 31 -32
American Nurses Association, Division of
Gerontological Nursing, 187
Antidiscrimination legislation, 94. See
also Medicaid, discrimination
Automatic cancellation clause, 151, 157- 158
B
Barthel Index, 57
Bed supply
control of, 5, 17, 18
policy, 23, 43-44, 190, 199
Beds
demand, 10, 23, 196- 197
Medicare and Medicaid, 9
notification of lapse of hold period, 28
occupancy rates, 199
per 1,000 population, 199, 361
per licensed nurse, 102, 362
totals during 1978-1983 by state, 360
Bedsores, see Decubitus ulcers
Beverly Enterprises, 187
Board and care homes, 8
Board of Internal Medicine, 4
C
Care conferences, notification, 30
Case mix
referencing in survey protocols, 110,
115-118, 191
reimbursement systems, 66, 92
staffing according to, 102
stratification, 131
use for measuring outcomes, 63-64
Certificates of need, 189
Certif ication
Distinct party 94
expenditures, 169
federal-state role relationships, 38, 104
of geriatric competence, 4
requirements, 32
state resources committed to, 315
temporary, 156
Certification regulations
conceptual basis, 71
costs of revision, 247
dissatisfaction with, 70
distinction between SNFs and ICFs, 69
HCFA requirement to modify, 15
post-1974 efforts to revise, 245
proposed, 247
proposed changes in, 25-32, 206-207
407
OCR for page 408
408 / INDEX
purpose of, 6
state views on, 325-327
Charge nurses, nursing home duties of,
101. See also Nurses
Civil fines, 166
Cognitive function testing, 59, 116
Cognitive impairment, 84
Commission on Chronic Illness, 239
Complaint investigation, 34, 105, 108,
121, 124-125, 138
Comprehensive Assessment and Referral
Evaluation Instrument, 59
Conditions of participation
administration (proposed), 29-31, 81,
88-89
dental services, 280
dietetic services, 83, 275-276
disaster preparedness, 29, 290
federal, state, and local regulatory
compliance, 254-255
governing body and management, 29, 3'
95, 255-269
improvements needed in, 22, 77-98
infection control, 289-290
laboratory and radiological services,
29, 279-280
medical direction, 29, 269-270
medical records, 29, 282-284
nurse's aide training, 29, 81
nursing services, 79-80, 83, 271-275
patient activities, 282-284
pharmaceutical services, 278-279
physical environment, 285-289
physical services, 270-271
proposed, 80-81
resident assessment, 25-26
residents' rights, 27-29, 81
skilled nursing facility, 26-27, 77-80
social services, 32, 83, 99, 281-282
specialized rehabilitation services,
276-278
transfer agreement, 29, 284-285
utilization review, 29, 290-297
vagueness-in, 79-80
Congregate care, 8
Consultants to nursing homes, 150
Consultation, guidelines needed on, 154
Consumer advocates
concerns, 7
effectiveness of, 41
lack of, 5
role, 19-20, 173- 183
Consumer protection, 173, 178
Contractures, 84, 118, 119, 121
Correction plans
content, 152
duration and number, 154
evaluation of, 150
federal criteria for, 152
guidelines needed on, 154
noncompliance with, 152
revision of, 154- 155
.
state review procedures for, 152
verification, 321-322
Council of State Governments, 240
D
Data collection
improvements needed in, 22
instruments, 56
on surveys, 37
Day-care centers, 8
Decertification
appeals of, 159- 160
grounds for, 149, 156- 157
invocation, 13, 104
need for, 154
of SNFs, 78
voluntary, 157
Decubitus ulcers, 62, 80, 84, 116-119,
121, 379
Dehydration, 84, 118, 119, 121, 380
Demographic trends, 10, 17, 196- 197
Department of Health, Education, and
Welfare, lawsuit against, 16
Depression, 49
Deregulation of nursing homes, 4
Directors of nursing, nursing home duties
of, 101-102
Domiciliary care, 8
Elderly, cause of functional impairments
in, 52
Employment estimates for nursing and
personal care facilities, 10
Enforcement
attitudes and, 13, 147- 149
data availability, 170
federal funding of, 169- 170
formal, initiation of, 153
goal of, 148
inadequacies, 146- 147
laxity, 7
legal staff for, 322
policies, improvements needed in, 22,
147-149
of residents' rights, 85
state variations in, 40, 241, 321-325
written guidelines for, 323
Enforcement procedures
detailed, 154
federal, 150- 161
state, 162- 169
Expenditures, nursing home care, 10
Extended care facilities (ECFs)
federal standards for, 14
funding of, 241
problems, 241
See also Nursing homes
Extended survey
basis, 115, 123, 383
finding followed by sanctions, 154
triggering, 120- 123
See also Surveys
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INDEX / 409
F
Federal funding
enforcement activities, 169- 170
OAA payments, 239
ombudsman programs, 41, 179
state survey and certification
activities, 36
state survey agencies, 132- 135
Federal regulation of nursing homes,
history of, 238-253
Financial information, nursing home care,
18-19
Free market, see Deregulation of
nursing homes
Functional competency/impairment
assessment, 57-58
G
Geriatric Mental Status Schedule, 59
Geriatrics, importance of, 3, 186
Gerontology, nurses' training in, 101
186-187
H
Health Care Financing Administration
expenditures for state survey
activities, 133-135, 373
hearing and appeal procedures, 159
look-behind authority, 138- 139
monitoring staff and responsibilities,
137-140
requirement to modify federal
certification regulations, 15
Health insurance coverage for nursing home
care, 17
Hill-Burton
fire and health standards, 13, 240
hospital construction program, 238
Hill-Burton Act, 239
Hillhaven Corporation, 65, 187
Home health services, 8
Hospitals providing ICE services,
standards for, 314
Hyperthermia, 97
Hypothermia, 97
I
Incentives, good nursing home performance,
35, 126-127, 188-189
Index of Activities of Daily Living, 48
Infections, 84, 118, 121, 379
Information reporting requirements, 17
Inspections
food, 33
life safety code, 33
number of, 133
nursing home, 1, 104
state resources committed to, 315
Inspections of care
current requirements, 105
integration with survey, 38, 211
regulations governing, 141
review frequency, 140
Intellectual impairment, 49
Intellectual impairment/behavioral problem
assessment, 58-60
Intermediate care facilities (ICFs)
accreditation, 1
certification regulations, 14, 69-74
cost of elimination of, 212
development of regulations for, 244
establishment, 242
failing to meet conditions, 149
Medicaid reimbursement rates for, 72, 367
number and percentage by state, 72, 357
regulatory requirements, 9
resident-days of care reimbursed, 368
See also Nursing homes
Intermediate care facility standards
administration, 297-305
current, 297-314
environmental and safety, 306-308
health services, 310-312
meal service, 308-309
medications, 309-310
physician services, 314
rehabilitative services, 312-313
safety, 305-306
social services, 313
Intermediate care services, standards for
facilities providing, 314
J
Joint Commission on Accreditation of
Hospitals, 1, 185-186
K
Katz Index of Activities of Daily Living,
57
Kenny Self-Care Evaluation, 57
Kerr-Mills Act, 239
Key indicators of resident care
dietary, 381-382
environmental, 114, 382
examples of, 378-382
operational use of, 383-385
use in surveys, 34, 64, 113-116, 118-120
L
Licensed practical nurses in nursing
homes, 73, 101-103
Life expectancies, 370
Life safety code
deficiencies, 245
inspections, 33
Linn's Rapid Disability Scale, .
Long-term care
demonstration projects, 200
financing, 199
types, 8
Long-Term Care Ombudsman Program, 20
Long-term-care services
alternatives tot 197
available in 1985, 8
OCR for page 410
410/ INDEX
community-based, 5
for disabled elderly, 8
home-based, 5
M
Malnutrition, 84, 118, 121
Management Minutes System, 65
Medicaid
advent of, 241-245
beds, number of, 9
discrimination, 29, 30, 81, 91-95. See
also Antidiscrimination
legislation
eligibility, 5, 18, 75, 104, 190
expenditures for nursing home care, 194
fraud unit, 125
funds, allocation of, 245
legislation, amendments, 14
program, sanctions under, 165
surveillance program, 141
termination, 154- 157
utilization control program, 141
Medicaid budgets
federal contributions to, 194
growth control, 5, 18, 23, 198, 367
increases, 74
Medicaid matching funds
reduction of, 139
withholding from states, 37, 38
Medicaid payments
facilities not receiving, 9, 78
to nursing homes, 5
policies, see Medicaid reimbursement,
. .
po 1cles
suspension for new admissions, 13,
158-161
Medicaid Provider Agreement, 30
Medicaid reimbursement
policies, 17, 18, 22-23, 43, 193- 196
rates, 6, 17, 57, 72, 76, 92-93, 198
Medicaid statutes
amendment, 39-40
duty imposed on Secretary of HHS by, 16
Medical Assistance for the Aged, 239
Medical care indicators, 380
Medical records access, 28-29, 173- 174
Medicare
advent of, 241-245
beds, number of, 9
budgets for certification, 133
certification, federal funding for, 133
eligibility, 75
participation in 1966- 1967, 148
payments, facilities not receiving, 9
Medicare and Medicaid acts, passage of, 240
Medications, as key indicators of resident
care, 378-379
Mental depression, 116
Mental Status Questionnaire, 59
Mini-Mental State Examination, 59
Monitoring
nursing home performance, 12, 32-38, 75,
104-145
outcomes, 64
state activities, 105
Montana resident classification scheme, 64
N
National Center for Health Statistics
surveys, 19, 192
National Citizens' Coalition for Nursing
Home Reform study on care quality,
51-52
National Committee on Vital and Health
Statistics, 192
National Health Corporation, 65, 187
National League for Nursing, 187
National Summary of State Nursing Home
Ombudsmen Reports for the United
States, 92
New York State Department of Health,
case-mix reimbursement system, 65-66
Noncompliance
extended survey for, 122
history of, 156
Notification of resident transfer or
discharge, 28-29, 81, 95-96
Nurses
number of licensed, 362
nursing home duties of, 73
ratio of RNs to LPNs in 1981, 362
shortage of, 74
training in gerontology, 101, 186-187
wages, 1 0 1
See also Charge nurses; Licensed
practical nurses; Registered nurses
Nurse's aides
importance, 52
problems, 11, 101
training, 29, 30, 73, 81, 89-91, 366
turnover rate, 11, 73, 90, 101
wages, 101
Nursing
care indicators, 380
hours per resident-day, state minimum,
365
labor assessment, 65
time requirements, 65, 200
Nursing home care
alternatives to, 23, 199-200
conflicts of values and ethics in, 52-53
cost assessments, 65-66
expenditures, 10
goals, 48
high-quality, requirements for
providing, 48-49
inadequacies in, 21
need for, 197
payment for, 17
Nursing home compliance
determinations, 107
with federal standards, 14
Nursing home costs
for resident assessment system, 212
reduction measures, 10, 194
Nursing home industry
OCR for page 411
INDEX / 411
growth, 7, 238
professionalism in, 185- 188
Nursing home regulation
activities, survey of, 318
federal role, 12, 142- 145
goals, 2
history, 13
improving effectiveness, 191
resident-centered, outcome-oriented, 27
state role, 12, 142- 145
state/federal role restructuring, 142-145
strengthening government role, 21-22
Nursing home service
needs assessments, 65-66
use and cost predictions, 57
Nursing homes
access problems, 92, 195
accreditation, 1
administrators, professionalism of, 186
admission eligibility criteria, 72-73,
198
A-key deficiencies by state, 377
attributes of quality in, 45-50
authority to close, 167- 168
basis for certifying, 243
bed demand, 10, 196- 197
bed supply, 5, 197-200
certification, post-survey phase, 151 - 152
chains, quality assurance programs of,
187
characteristics, lack of information on,
18
choosing, 5, 6
chronic problems, 149
chronically out of compliance, 146
community involvement in, 19-20, 171,
184-185
consumer involvement in, 171
compliance determinations, 107
compliance with federal standards, 14
construction, 190, 239
deficiencies, correction of, 153
deregulation, 4
distinctions between ICFs and SNFs, 71-74
elimination of distinctions between
types, 25
expenditures, 239
fire, 242
food, 51
food poisoning in, 242
for-profit percentage, 10, 194
goals of federal regulation, 67-68
government-owned and -operated
percentage, 10
health professional school ties with, 186
history of federal regulation, 238-253
information systems, scope and design
of, 190~193
inspection and cost reports, 41, 174
LPNs needed in, 363-364
management and staff motivation, 171,
185-189
Medicare and Medicaid, 143
motivation and attitudes of owners,
managers, and staffs, 20
national totals by certification status,
355
nonprofit percentage, 10
number and percentage by bed size and
state, 359
number of by certification status and
state, 356
number operating in 1954, 236
number operating in 1985, 9
occupancy rates, 5, 190, 201-202
operations, information collection on,
193
ownership status by state, 358
ownership, definition of, 161
paper reviews of, 144- 145
performance monitoring, 32-38, 104- 145
personalization of rooms, 11
physical environment in, 31-32, 47-48,
97-98
physician roles in, 186
poor vs. good quality, 11
populations, 5, 8, 9
problems, 2, 242
recertification, 147, 149
regulated types, 9, 71
resurvey of, 34
revenues from Medicaid, 5
rooms, single vs. multiple occupancy, 44
social services, 31
staff turnover, 112, 173
staff-to-resident ratios, 54
staffing, 10, 32, 44, 49-50, 72-74, 80,
98-103, 173, 190, 200-201
standard for certification of, 147-148
standards, state variations in, 241
state differences in licensing criteria,
.
72
state inspection of, 1
substandard, 148
survey agency consultation with, 150
temperatures, 97-98
time devoted to survey process, 80
transfer opportunities, 6
use of resident assessment data, 75
in violation of Medicaid standards, 243
withholding federal funds from, 242
See also Extended care facilities;
Intermediate care facilities
o
Office of Long-Term Care, 246
Office of Nursing Home Affairs, 14, 244,
245
Old Age Assistance, 238, 239
Older Americans Act, 20, 41, 44, 97,
175-176, 180, 206
OMB Circular A-122, effect on ombudsman
program, 42, 180- 181
Ombudsman programs
OCR for page 412
412/ INDEX
AoA commitment to, 179
constraints, 180
funding of, 179
legal support for, 180
national extent of, 177- 178
national leadership for, 42, 179
responsibilities, 176- 177, 180
state survey agency relationships with,
108, 182-183
statutory authority for, 175- 176, 179
strengthening of, 41-42, 179
written agreements with, 42
Ombudsmen
access to residents, 31, 96-97, 180
complaint handling by, 177
definition, 177
lobbying by, 180
role, 177, 178
Quality assurance
components, 12, 60-61, 69-71
interpreting and using information for,
61 -68
programs, nursing home chains, 187
Quality of care
effects of Medicaid reimbursement
policies on, 23
factors affecting, 17-21, 41-42, 45-50,
60-61, 171-189
incentives to ensure, 188
indicators, see Key indicators of
resident care
instruments for assessing, 56-60
measurement of, 61-62, 64, 83
process for ensuring, 10
standards of reference, 62-63
Quality of life
Omnibus Budget Reconciliation Act, 138, 158 condition of participation, 27, 79, 81-83
Organic brain syndrome, 59 effects of Medicaid reimbursement
Outcomes
case mix in measuring, 63
components, 5S-56, 74
measurement of care quality, 64, 74-75,
83-84, 118-120
negative, 84, 114, 121, 122
positive, 84, 114
Overmedication, 84, 116
p
Paperwork reduction, 89
Patient Appraisal and Care Evaluation, 246
Patient Assessment Computerized system, 65
Patient Care and Services (PaCS), 130-132
Patient care management system, 16
Patient Care Profile, 65
Patient Classification for Long-Term Care,
56, 249
Patient classification system, information
needs of, 56
Personal care indicators, 380
Philadelphia Geriatric Center Mental Status
Questionnaire, 59
Physical environment in nursing homes,
31-32, 81, 97-98
Physical restraints, 84, 116, 118, 121
Populations
85 and older, 10
elderly, by state, 369
over age 75, 10
Private-pay rates, 94
Prognostic adjustment factor, 64
Provider
agreement termination, 156- 157
concerns, 7
Psychotropic drugs, 54, 118
Q
Quality assessment criteria
outcome component, 55-56
process component, 54-55
structural component, 53-54
policies on, 23
factors affecting, 41-42, 51-53,
171-189, 382
process for ensuring, 10
R
Receivership, 166- 168
Recertification, 147, 149, 155- 156
Recommendations
amendment of Medicaid statutes, 39-40,
155, 168, 205
amendment of Social Security Act Title
XIX, 36, 135
changes in federal certification
criteria, 25-32, 74, 77, 80, 81,
85-89, 91, 95-98, 204
complaint handling, 34, 125
consolidated "Administrations condition,
29-31, 88-89, 204
cost implications of, 210-212
data collection and analyses, 37, 137
elimination of distinctions between SNFs
and ICFs, 25, 74, 204
elimination of institutional reports,
30, 89, 204
enforcement, 38, 168, 170, 205-206
environmental standards, 31-32, 98-100
extended survey for sample of
facilities, 36, 128
federal funding, 36, 135
federal oversight of survey operations,
37, 38, 139-140
federal-state certification role
relationships, 38, 145
incentives, 35, 127
integration of inspection of care, 38,
142
Medicaid discrimination, 30, 95, 204
Medicare/Medicaid survey and
certification requirements, 32, 111
notification, 30, 96, 204
nurse's aide training, 30, 91
OCR for page 413
INDEX/413
nursing home inspection and cost
reports, 41, 174
nursing home staffing, 32, 100
ombudsmen, 31, 41 -42, 97, 181 - 183
quality assessment in survey process,
34, 124, 205
quality of life as a condition of
participation, 27, 81, 204
resident assessment, 25-26, 77, 204
resident interviews, 35, 124
resident participation in facility
decision-making, 31, 96, 204
resident-centered, outcome-oriented
approach to regulation, 27, 85, 204
residents' rights as condition of
participation, 27-29, 86-88, 204
resurvey, 34, 123, 155
rewriting of SNF conditions and
standards, 26, 80, 204
room occupancy, 44, 202
social services, 31-32, 97-99, 204
strengthening state regulation, 36, 135
survey development, 35-36, 120, 205
survey instruments and protocols, 33,
115, 128
survey team staffing, 37, 136
survey timing, 32-33, 113
surveyor qualifications, 37, 136
surveyor training, 36, 37, 129, 137
withholding Medicaid matching funds fron
states, 37, 38, 140
Registered nurses
in nursing homes, 101- 103
minimum number in nursing homes, 73
Regulation, see Federal regulation of
nursing homes, history of; Nursing home
regulation
Regulations, 6, 7
combining SNF and ICE requirements, 15
HCFA-proposed, 15
proposed, 16
state, steps to strengthen, 36
state, use of resident assessment data,
75
See also Certification regulations
Regulatory changes
opposition to, 2
proposed, 1, 2, 16
Regulatory costs of recommendations,
211-212
Regulatory policies affecting quality of
care, 17-19
Regulatory quality assurance goals, 67-68
Regulatory standards, violations of, 15
Regulatory system
components for quality assurance, 12
goals, 12
improvements needed in, 22-23
Rehabilitation
exercises, 52
services, intensive short-term, 9
Rehabilitation Act, 1974 amendments to
section 504, 93
Rehabilitative care indicators, 380
Resident assessment
audit, 113-114, 191
data computerization, 77, 187, 191-192
data system, 25-26, 43, 48, 49, 61-67,
73-77, 84, 102, 119, 128, 132, 135,
191-193, 207-211
data uses, 75, 115, 119, 191
instrument development, 76, 79, 117
scores, 115-116
system, cost to nursing home, 212
Resident care
management system, proposed, 15
needs, 46-47
planning, 49-51, 75
Resident mix
in SNFs and ICFs, 10
optimization, 17
Resident participation
in advisory and family councils, 29, 87
in care planning, 51
forms of, 31
in management decision-making, 19-20,
29, 31, 81, 96, 172-173
in social, religious, and political
activities, 29, 51, 88
Resident-staff relationships, 11, 52, 173
Residents
75 and older, 10, 46, 73
85 or older, 10, 196-197
ability of to choose among nursing homes, 5
abuse, 3, 121, 173
accidents, notification of, 30
bed-bound, 80, 116, 117
characteristics, 46
charge assessment, 65
classification instruments, 57-58
clinically depressed, 121
dependencies of in activities of daily
living, 372
differences in social circumstances, 46
disabilities, 5
discharge, 28
financial status, 6
functional status, 48-49
heavy care, 9, 73, 91 -93, 103, 196, 198,
199, 212
interviews with, 35, 121, 123- 124
lack of information on, 18
lack of privacy, 51
length of stay, 46-47
Medicaid/Medicare, 17
mental status, 49, 116-117, 118, 121,
381, 384
needs, insensitivity to, 107- 108
neglect of, 3, 121, 173
non-English speaking, 28
ombudsman access to, 31, 96-97
outcomes, factors influencing, 55
physical inactivity of, 84
physically dependent, 117, 119, 121
OCR for page 414
414/ INDEX
physically independent, 118
population, heterogeneous, 8
private-pay, 5, 17
projected number in 1980-2040, 371
receiving public assistance, 239
relocation of from substandard
facilities, 322
satisfaction assessment of, 60
social activities, 51
spending down by, 5, 19, 93-94
stratification, 116
transfer of, 28, 167
treatment plan, 48
under age 65, 8
weight loss in, 119, 120
Residents' rights
language arrangements for non-English
speakers, 28, 86
legal, 28, 86
medical and social records, 28, 87
notification of transfer, discharge,
lapse of bed-hold periods, 28-29, 86
sanctions for violations of, 165
standard, elevation to a condition, 15,
27, 81, 85-88
violations of, 7
written facility policies, 28, 87
written statement of, 28
Resource Utilization Groups classification
system, 57, 66
S
Sanctions
against chronic or repeat violators,
39-40
appeals of, 159
application of, 148
factors influencing use, 162, 323-324
favorably rated, 164, 325
federal, 13, 154, 156
imposition of, 151
initiation of, 154
intermediate, 39, 159, 162- 169
number applied in 1983, 162, 323-324
number available by state, 322
obstacles to successful use, 164
procedures for implementing, 165
repeat deficiencies, 155
residents' rights violations, 165
state, 162-168
state availability and use, 13, 315
state variation in, 321
statutory availability and use, 315
types, 155-161, 163, 165-168
use of prior survey findings in
applying, 160
withholding certificates of need, 189
Senile dementia, 49, 58
Skilled nursing facilities (SNFs)
accreditation of, 1
certification regulations, 14
conditions of participation, 26,
77-98, 254-297
Recertification of, 78
development of regulations for, 244
federal standards for, 14
implementation of regulations for, 242
Medicaid reimbursement rates for, 72
Medicaid reimbursement rates per
resident-day, 367
number and percentage by state, 72, 357
number failing to meet conditions of
participation, 149
providing ICE services, standards for,
314
regulatory requirements, 9, 69-74
resident-days of care reimbursed, 368
staffing, 72
use of ECF standards for, 242
Social isolation, 84, 85
Social Security Act
amendment of Title XIX, 36, 135, 204-206
1950 amendments, 238
1956 amendments, 239
section 1864, 143- 144
standard-setting amendment, 240
Title XIX, 133
Social services, nursing home, 31, 81,
99-100
Social workers required for nursing
facilities, 32
Standard survey
basis of, 114-115, 123
deficiencies found in, 154
process, scope of, 33-34
protocol, 131
resident categories, 120
scope of, 118, 121
shorter, 110
validity of, 128
See also Surveys
Standardized instruments for resident
assessment, 64, 74
Standards
ambiguity of, 7
improvements needed in, 22
inadequacies in, 7, 70
licensure, state variations in, 13, 72-73
state regulatory, 319-320
See also Intermediate Care Facility
standards; Process standards
State licensure and certification
agencies, survey of, 315-350
State regulatory capability, increasing,
132-140
State survey agencies
activities, expenditures for, 133-135,
373-374
budgets, state variations in, 318-319
consultation, 150
enforcement procedures and guidelines
of, 153
funding and staffing variations, 109, 375
HCFA expenditures for, 133-135
performance evaluation, 138
OCR for page 415
INDEX/415
relationships with ombudsman programs,
108, 182-183
sanction authority, 322-323
staffing, 375
workloads, 319
Stroke patients, rehabilitation services
for, 9
Survey agency
personnel, state variations in, 318-319
sanction application by, 148
staffs, 40, 107, 109, 169, 211
statement of deficiencies, 151
Survey instruments
design, 116- 117
reliability and validity of, 127-128
Survey operations
dissemination of data on, 137
federal oversight of, 37, 104, 138, 149
Survey procedures
consolidation of Medicare and Medicaid.
111
current, 148
development of, 209
state variation in, 320-321
Survey process
complaint handling in, 34
continuing improvement of, 127- 129
criticism of, 129
enforcement problems in, 246
extended, scope of, 33-34
federal requirements for, 15-16
improvements needed in, 22, 70
insensitivity to resident needs, 107-108
problems with, 105- 109
purpose, 104
quality assessment in, 34
redesign of, 109- 129
simplification of, 88
state variations in, 108
time requirements for nursing homes, 80
Survey protocols
basis, 109
case-mix referencing in, 110, 115- 118 V
development, 35, 117
focus of, 122
HCFA, 130
resident-outcome oriented, 131
short, 114
testing of, 36, 128
Survey team composition, 37, 136
Surveyors
attitudes, 150
authority, 321
concerns, 79
judgment, 71, 79-80, 108, 109, 120,
131-132
number of, 133, 139
qualifications, 36, 37, 136
responsibilities, 150
roles, 149
training, 36, 129, 136- 137, 152, 169,
170, 244, 320
Surveys
after changes in ownership, 112
consumer involvement in, 125- 126
costs, 135
current requirements, 105
data sources, 123- 124
federal look-behind actions, 13
follow-up procedures.
forms, 70, 130- 131
instruments, 33, 116, 123, 127- 128,
209-210
intensity of, 107
of nursing homes and residents, 19
of state licensure and certification
agencies, 315-350
outcome-oriented, 119
policies, current, 148
predictability of, 106- 107, 110
purpose, 116
questionnaire, 327-350
requirements, 32
results, consistency of, 129
scoring procedures, 109, 122
timing and frequency of, 32-33, 106-107,
111 - 113
validation, 138
visits, 1980 total, 376
See also Extended survey; Standard
112, 149, 150-154
survey
U
U.S. Senate Special Committee on Aging,
14, 91, 240
Urinary incontinence, 84, 116, 379
Utilization review, 141 - 142
Violations
authority to punish, 148
ma jor, 161
regulatory standards, 15
repeat, 160-161
residents' rights, 7
W
Well-being
objective, 53
subjective, 54, 59
OCR for page 416
Representative terms from entire chapter:
nursing homes
