Today I want to share with you some important information about bloodborne pathogens. This bloodborne pathogens infographic is provided to us courtesy of Compliance and Safety. This is just one of many things a Nursing Home and Hospital Surveyor looks at when surveying a health facility. Of course, the risk of exposure to bloodborne pathogens is quite high in a health facility. Safety procedures and processes are important to not only protect the staff but also the resdients/patients. You can see how it is higher in certain healthcare areas when compared to others. – JL

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A patient in a North Carolina nursing home was allowed to fall by a nurse aide. The aide and her friends/coworkers covered it up and for two weeks the patient was untreated for a hip fracture. She was eventually taken to a hospital and there it was found she had a broken hip. Shocked by the news, the family eventually was able to find out what happened. The resident’s family learned what happened only by reviewing follow-up reports from state inspectors.

As we know, rules and regulations get through “channels” and many times they do so without anyone noticing. That has happened again. A recent change in federal rules on nursing home inspections makes it nearly impossible for families to get the information they need to protect their loved ones.

According to the associated press, the changes were put into effect in October 2008 with little notice and without a public comment period. The change is getting sharp criticism for closing off critically important information. Under the new rules, the state inspector follow-up reports can’t be released without specific approval from the chief of CMS.

“It’s an extremely troubling development – it puts a lot of information related to nursing-home inspections off-limits,” said Eric Carlson, director of the Long-Term Care Project of the National Senior Citizens Law Center, a California-based nonprofit group funded in part by the federal Administration on Aging. “I think it’s certainly bad for consumers and the folks who represent them.”

The change bars nursing home surveyors from releasing privileged information to the public without approval from the Director of the Centers for Medicare and Medicaid Services. State employees (the nursing home and hospital surveyors) who perform inspections for the federal government have been reclassified as federal employees as part of the revision. This reclassification is only for this purpose, and not for wages/benefits or other purposes. The surveyors are still state employees. They contract to the Federal government to perform the surey and certification work and as such are required to follow federal standards and procedures, and in this case, are required to follow the federal procedures for the release or non-release of privileged resident/patient information.

Officials at the Department of Health and Human Services said employees have been too burdened by requests for information. Under the rule change, state employees who inspect nursing homes for the federal government are reclassified as federal employees who aren’t allowed to provide “privileged” information or documents to the public without approval from the head of the Centers for Medicare and Medicaid Services.

Requests were diverting employees from certification responsibilities, Michael Leavitt, secretary of the Department of Health and Human Services, said in announcing the change.

Lawyers are now finding out that the new rule has already slowed efforts to represent their clients. It is slowing down the process to get the information they need.

How does this affect you, the consumer? – You can see, it is putting a wall in your path to ensuring your loved ones are getting safe care.

What about those of you who are administrators and staff of nursing homes – now is it affecting you? You might think at first, that it is a good thing, but really, getting information out to the public about both GOOD and BAD state inspections is beneficial to the facility and to those who are wanting to look at where to place their loved ones.  I would think even those who administer nursing homes find the change in rules, without a public comment period, to be a poor decision.

Then look at who has to give the permission – the head of CMS – the head of a federal agency is going to review and provide permission for the hundreds of requests in every state? That sounds like an impossible task, the permission is either going to be given or withheld willy-nilly. What determines who gets permission to see the documents and who doesn’t? Will there be criteria? Who is developing that criteria? What patient rights are being stepped on here?



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I’ve been busy with surveys and issues coming up regarding surveys that I haven’t had the chance to take time to continue writing. I’m taking a few moments now. I just want to comment on something affecting all of us – the current economic climate. I know how it is affecting me, and I’m sure you are feeling the pinch as well.
The current climate is affecting nursing homes and hospitals as well as the regulatory agencies that govern them.
Many of the nursing home and hospital operators, when asked, may say they are taking steps to reduce costs but will pledge to refrain from cuts that could impinge on the care they offer their residents. This is going to be difficult, especially as “private pay” patients become fewer, Medicare starts looking closer at what they are paying for, and Medicaid continues to cut back and not maintain pace with rapidly increasing healthcare costs.
What might you expect to see? You may see an increased dependence on volunteers. This can be good, but it can go sour quickly if things are not monitored well. Volunteers need to have training and monitoring to ensure they are doing only what they are allowed to do, and that they are doing it appropriately.  Volunteers should not be providing care that only a healthcare professional can provide.
You might also see a reduction or lack of maintenance on the physical aspects of the building. It is important, though, that regular maintenance be provided to keep such things as fire sprinklers, washers, dryers, medical equipment, and kitchen equipment working correctly.
On the “state” side of things, you may see a decrease in the number of people willing to do the survey work. It is a hard job, not as easy as many people envision. It takes a lot to go into facilities, find the problems, get enough evidence to support them so they can stand up to a legal challenge, learn to write them up in the correct way (the lack of a word or two, or failing to use one word instead of another can have a whole deficiency thrown out the court window), and then get them issued following proper procedures. In addition, many states think so low of their nursing home and hospital surveyors that they pay those employees very low wages compared to what they could get in the private sector. Now there are many fine high quality people in this line of work who do care and the money is not why they are doing the job. But, when wages are so low as compared to private sector work, where do you think the majority of well-qualified staff go – certainly not to work for the state agency.
So the economic crisis may have the unintended effect of fewer surveys, fewer “substantiated” issues, and more cries of “poor care” unheeded and unheard.

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