Quarterly Meeting Update with Residential Care Services and CMS Region X Office

Quarterly Meeting Update with Residential Care Services and CMS Region X Office

F-600 Abuse and Neglect
We had asked for clarification at our last meeting as to whether it was appropriate for Surveyors to suggest to Providers that any resident to resident incident was an “automatic G citation”. Many of our members have been told this during both standard surveys and complaint investigations. Surveyors have stated that this is being directed by CMS.

CMS recently clarified this with the Central Office in Baltimore and we were told the following: Surveyors are to not state that resident to resident altercations are an “automatic” citation. The surveyors must complete their investigation of the incident. If during this investigation, it is determined that the action was “abuse” by definition (willful intent by a resident to act without regard to intent to harm) then a citation would follow if surveyors also find that the facility failed to keep the resident free from abuse. Deb Murphy, CEO at LeadingAge Washington expressed her disappointment in this interpretation, she stated she believed this would have a chilling effect on providers’ willingness to care for residents with dementia. Removal of the use of the word “automatic” does not change the outcome of failed practice and continues to expose providers to a strict liability-based citation. Resident to resident dementia-based impulses, with or without any behavioral history, can not be absolutely controlled or prevented by providers. In the absence of finding that the provider failed to take appropriate and reasonable action to prevent resident to resident incidents, a citation should not attach.

Murphy asked CMS Region X to revisit this decision with Central Office (CO) and the unintended impact this will have on providers and residents. Region X representatives agreed to follow up with CO again and will present to them an example of a resident to resident altercation that all agreed was unpreventable and unreasonably resulted in a citation.

RCS has also offered collaborative training done in the near future with the Behavioral Support Team they are forming.

Appendix Q Update
The new Appendix Q of the State Operations Manual with the revisions made to the Guidelines for Determining Immediate Jeopardy is expected to be issued at beginning of the year or not later than early spring. There will be joint training on the new guidance with RCS, CMS, LeadingAge Washington and WHCA.

Quarterly Survey Information Update
Candace Goehring from RCS presented the updated quarterly survey information from QCOR. The most noticeable change has been in the number of Immediate Jeopardy citations, which have decreased significantly from the same quarter in 2017. The top citation right now for IJ’s, in both standard surveys and complaint investigations, is F689 Accidents and Hazards with the most common citations being written for smoking and elopements. Please see below.

We have asked to continue to meet quarterly with RCS and CMS, we would like to start reviewing G level citations to assess for opportunities for education to members.

Washington State, Nursing Facility Health and Complaint Survey Data prepared (November 2018)