How To Read a Nursing Home Inspection Survey To Identify Abuse or Neglect
All nursing home providers participating in the Centers for Medicare & Medicaid Services (CMS) program must meet Federal reporting requirements as well as state laws as they relate to the Illinois Nursing Home Care Act. Homes must also remain in substantial compliance to remain in operation and be evaluated for care standards through annual surveys and inspections. It is expected that any recorded violation will then be addressed promptly and residents will no longer be at risk from those noted deficiencies.
Families can review a website published by CMS called Nursing Home Compare. Here, they can access quality of care information for every nursing home that participates in Medicare and Medicaid in Illinois. Nursing Home Compare provides an overall star rating based on three factors: health inspections, staffing levels, and quality measures, but also includes the results of recent health inspections.
- Find out the CMS quality rating of your loved one’s nursing home through Nursing Home Compare.
- Review the “STOP” sign warning icon which highlights facilities that have been cited for abuse where residents were found to be harmed or cited for abuse where residents were found to be potentially harmed.
- Become familiar with the 22 known Illinois Special Focus Facilities (SFF). SFFs have a “persistent record of poor care.”
- Review Illinois’ nursing home violator’s list.
A List of Common Terms and Definitions Used in Illinois Nursing Home Survey Reports
The inspection reports are outlined in codes and use language most individuals would not be familiar with, causing some confusion. However, the Illinois nursing home neglect and abuse attorneys at Levin & Perconti, with the help of CMS reporting, put together this list of definitions and acronyms most commonly used in CMS surveys of Illinois nursing homes.
- Abbreviated Standard Survey: A survey other than a standard survey that gathers information primarily through resident-centered techniques on facility compliance with the requirements for participation. An abbreviated standard survey may be premised on complaints received; a change in ownership, management, or director of nursing; or other indicators of specific concern.
- Abuse: The willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain, or mental anguish.
- ACO: Automated Survey Processing Environment (ASPEN) Central Office
- Act: The Social Security Act
- AEM: Automated Survey Processing Environment (ASPEN) Enforcement Manager
- ASPEN: Automated Survey Processing Environment
CASPER: Certification and Survey Provider Enhanced Reporting
- Certification of Compliance: The facility is in at least substantial compliance and is eligible to participate in Medicaid as a nursing facility, or in Medicare as a skilled nursing facility, or in both programs as a dually participating facility.
- Certification of Noncompliance: The facility is not in substantial compliance and is not eligible to participate in Medicaid as a nursing facility, or in Medicare as a skilled nursing facility, or in both programs as a dually participating facility.
- CFR: Code of Federal Regulations
- CMP: A civil money penalty.
- CMPTS: Civil Money Penalty Tracking System
- CMS: Centers for Medicare & Medicaid Services (formerly HCFA)
- Deficiency: This means a skilled nursing facility’s or nursing facility’s failure to meet a participation requirement specified.
- DoPNA or DPNA: The denial of payment for new admissions.
- DPoC: A directed plan of correction.
- Dually Participating Facility: This is a facility that has a provider agreement in both the Medicare and Medicaid programs.
- Educational Programs: These programs include any subject pertaining to the long-term care participation requirements, the survey process, or the enforcement process.
- Enforcement Action: This means the process of imposing one or more of the following remedies: termination of a provider agreement; denial of participation; denial of payment for new admissions; denial of payment for all residents; temporary manager; civil money penalty; State monitoring; directed plan of correction; directed in-service training; transfer of residents; closure of the facility and transfer of residents; or other CMS- approved alternative State remedies.
- Expanded Survey: An expanded survey is the increase beyond the core tasks of a standard survey. A standard survey may be expanded at the surveying entity’s discretion. When surveyors suspect substandard quality of care, they should expand the survey to determine if substandard quality of care does exist.
- Extended Survey: A survey that evaluates additional participation requirements subsequent to finding substandard quality of care during a standard survey.
- Facility: A skilled nursing facility or nursing facility, or a distinct part of a skilled nursing facility or nursing facility, in accordance regulations.
- FSES: Fire Safety Evaluation System
- IDR: Informal Dispute Resolution
- IJ: Immediate jeopardy is a situation in which the facility’s noncompliance with one or more requirements of participation has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident.
- Immediate Family: These family members include a husband or wife; natural or adoptive parent, child or sibling; stepparent, stepchild, stepbrother, or stepsister; father-in-law, mother-in-law, son-in-law, daughter-in-law, brother-in-law, or sister-in-law; grandparent or grandchild.
- Independent IDR: An independent informal dispute resolution.
- LSC: Life Safety Code
- MAC: Medicare Area Contractor
- Misappropriation of Resident Property: The deliberate misplacement, exploitation, or wrongful, temporary or permanent use of a resident’s belongings or money without the resident’s consent.
- NATCEP: Nurse Aide Training and Competency Evaluation Program
- Neglect: The failure to provide goods and services necessary to avoid physical harm, mental anguish, or mental illness.
- New Admission: For purposes of a denial of payment remedy, means a resident who is admitted to the facility on or after the effective date of a denial of payment remedy and, if previously admitted, has been discharged before that effective date.
- NF: Nursing Facility
- Noncompliance: Any deficiency that causes a facility not to be in substantial compliance.
- No Opportunity to Correct (NOTC): The facility will have remedies imposed immediately after a determination of noncompliance has been made. No opportunity to correct.
- Nurse Aide: Any individual providing nursing or nursing-related services to residents in accordance with regulations.
- Nursing Facility: A Medicaid nursing facility.
- OBRA ’87: The Omnibus Budget Reconciliation Act of 1987.
- Opportunity to Correct: The facility is allowed an opportunity to correct identified deficiencies before remedies are imposed.
- OTC: Opportunity To Correct
- Partial Extended Survey: A survey that evaluates additional participation requirements and verifies the existence of substandard quality of care during an abbreviated standard survey.
- Past Noncompliance: A deficiency citation at a specific survey data tag that meets all of the following three criteria:
- The facility was not in compliance with the specific regulatory requirement(s) at the time the situation occurred;
- The noncompliance occurred after the exit date of the last standard (recertification) survey and before the survey (standard, complaint, or revisit) currently being conducted, and
- There is sufficient evidence that the facility corrected the noncompliance and is in substantial compliance at the time of the current survey for the specific regulatory requirement(s), as referenced.
- Per Day Civil Money Penalty: A civil money penalty imposed for the number of days a facility is not in substantial compliance.
- Per Instance Civil Money Penalty: A civil money penalty imposed for each instance of facility noncompliance.
- PNC: Past Noncompliance
- PoC: Plan of Correction
- QIES: Quality Improvement and Evaluation System
- Representative: For purposes of educational programs, means family members, legal guardians, friends, and ombudsmen assigned to the facility; for purposes of Independent IDR, means either the resident’s legal representative or the individual filing a complaint involving or on behalf of a resident.
- Self-Reported Noncompliance: Noncompliance that is reported by a facility to the State Survey Agency before it is identified by the State, CMS, or reported to the State or CMS by an entity other than the facility itself.
- SFF: Special Focus Facility
- Skilled Nursing Facility (SNF): A Medicare-certified nursing facility that has a Medicare provider agreement.
- SMA: State Medicaid Agency
- SQC: Substandard quality of care.
- Standard Survey: A periodic, resident-centered inspection that gathers information about the quality of service furnished in a facility to determine compliance with the requirements of participation.
- State Survey Agency (SA): The entity responsible for conducting most surveys to certify compliance with the Centers for Medicare and Medicaid Services’ participation requirements.
- State Medicaid Agency: The entity in the State responsible for administering the Medicaid program.
- Substandard Quality of Care: One or more deficiencies related to participation requirements, resident behavior and facility practices, quality of life, quality of care, that constitute either immediate jeopardy to resident health or safety; a pattern of or widespread actual harm that is not immediate jeopardy; or a widespread potential for more than minimal harm, but less than immediate jeopardy, with no actual harm.
- Substantial Compliance: A level of compliance with the requirements of participation such that any identified deficiencies pose no greater risk to resident health or safety than the potential for causing minimal harm. Substantial compliance constitutes compliance with participation requirements.
Before moving a loved one into a nursing home, we encourage family members to work with a health care provider, tour a home and interview the nursing director, and always do the research by reviewing health inspections, ask questions about staffing and resident’s rights, and understand how quality measures compare against others.
Report Nursing Home Abuse & Neglect Concerns
If you suspect an injury resulting from neglect or abuse at your loved one’s nursing home in Illinois, contact the attorneys of Levin & Perconti now at 877-374-1417 or 312-332-2872 to set up a free consultation with an experienced Chicago elder abuse lawyer.