In my last post I spoke of the need for reform in regards to the way the nursing homes operate. This post I will provide some of my own ideas on what I feel is needed.
First I will start with the North Carolina Department of Health Service Regulation NCDHSR. This is a branch of the North Carolina Department of Health and Human Services, which is the State level branch of Health and Human Services, a Federal agency.
The NCDHSR is responsible for the enforcement of nursing home regulations. They are the ones who are actually doing the inspections allowing the nursing homes to maintain their licenses. They are also the ones that conduct any complaint investigations against nursing homes. The investigations, or "surveys" are conducted by personnel hired from the nursing industry. They conduct their investigations in teams. They supposedly review medical records, interview residents and staff, and conduct walkthrough inspections.
When they are conducting an inspection they first report to the Director of Nursing to announce their arrival. The Director of Nursing then announces over the intercom that there are State inspectors on site. They also post a sign on all entry doors alerting anyone entering the building that they are being inspected. In my opinion, this is the first thing that needs to change. How do you expect to properly inspect a facility when the staff has an advance warning. The inspectors are usually the same people as well. The first thing the staff does is hurry from room to room to correct anything that was cited in previous inspections, or that is obviously a violation of the rules.
I would propose that inspections be conducted without warning or announcement. Do they really expect the staff to go about business as usual, knowing someone is watching? What would happen if the inspectors walked in the door just as visitors do? I am guessing that they would find more violations than they could write down. The way they carry out these inspections, it appears they don't want to find violations.
I realize that some of their rules are not as important as others, however they are still rules. As an example, they are supposed to post the staff levels and resident population daily in a conspicuous place. I was in Hendersonville Health and Rehabilitation during an investigation and the information posted was a week old. I reviewed the results of that investigation, and there were no violations found. Were they really looking or are these investigations simply a formality.
I also propose that someone who is not a former nursing home employee be on the team. I understand that there are HIPPA concerns, but these people would be no different than a receptionist in a doctors office. I believe that when you work in the business, you are used to working under staffed and out of empathy, ignore violations.
Then there are the interviews with residents. I am sure that most residents are afraid to tell the truth. They are already getting substandard care, and experience a great deal of intimidation. Knowing the workings of Hendersonville Health and Rehabilitation, the residents interviewed are probably chosen by the Director of Nursing. The ones that I've read do not reflect the overall treatment of patients.
There are also surveyors notes sheets. In Mom's case the surveyors notes contained two statements concerning a fall, each one said the opposite of the other. I was told that they were just a statement made by the Doctor. That is evidently enough for the NCDHSR, even though they are contradictory. I even went so far as to send them a copy of the notes, and asked for an explanation. They replied that the investigation was done in the past and that I could file another complaint if that wasn't good enough. Coincidentally the lead investigator Todd Davis, the same person that wrote the conflicting statements was promoted to regional director. Obviously incompetence is rewarded within the NCDHSR.
Reform would have start by dealing with the incompetence of the NCDHSR. Which would then lead to the NCDHHS. When I contacted Aldona Wos the Secretary of the NCDHHS, I was basically told that they would not even answer the question of why there were two different accounts of one incident.
More to come, this is just the beginning of what needs to be reformed!
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