WHCA/WiCAL staff recently met with Division of Quality Assurance (DQA) staff for our regularly scheduled quarterly meeting. These meetings focus on a discussion of survey and environmental trends that DQA staff is observing in the field as well as discussing issues of importance to WHCA/WiCAL and other Associations represented at the meeting.  Important takeaways from the meeting included:

• Facility Regulatory and Non-Regulatory Survey Trends:
  • Life Safety: We discussed the higher than normal recent incidences of fire in facilities across the state.  DQA asked the Associations to request of its members that they be especially vigilant with fire prevention as the weather continues to get colder.
  • Self-Reported Incidents: Facilities should include resident names (rather than relying solely on initials or codes) as well as a comprehensive set of facts surrounding the self-reported incident. Follow up actions, especially staff education, is especially important to include.
  • Complaints: Volume continues to rise.  The #1 complaint is not clinical; It is that phones are not being answered and voice messages are not being returned. The family then gets frustrated and contacts DQA because they cannot get a question answered or find out how their loved one is doing.
    • The Ombudsman’s office reiterated this concern, as local ombudsmen have also had experiences with lack of responsiveness from facility staff, and they believe their involvement could help address other complaints but they often are not hearing back in time.
    • Rotating Staff: DQA has recently seen an influx of complaints about facilities constantly rotating staff. They emphasized that this is not a regulatory violation. However, DQA personnel raised concern that while a facility may rotate staff so that staff becomes comfortable throughout the facility, it may also compromise the continuity of care and resident satisfaction as the resident (and family) are constantly seeing new people providing care. The point was made that while the facility’s intent is certainly well meaning, constant staff rotation raises the same concerns everyone had with the extreme use of agency staff.
  • Top Cited Nursing Facility Survey Deficiencies:
    • Abuse;
    • Fall with Injury or Death;
    • Failure to administer CPR when indicated; no evidence of Do Not Resuscitate;
    • Involuntary Discharge: This issue generated some discussion.  Associations raised concern about the increase of incomplete or misleading patient transfer information being received from hospital discharge planners, ie:  The resident who presents at the facility is not “the same resident” described in the discharge documentation.  In many of these instances, the facility unknowingly admits a resident who they do not have capacity to care for, is inappropriate for the facility or in the worst case, is a danger to other facility residents and staff.  DQA assured the Associations that they would consult their hospital regulatory colleagues to make them aware of the Associations’ concerns.
  • Facility Representation at DQA Nursing Facility Survey Immediate Jeopardy (IJ) Decision Calls: WHCA/WiCAL has long voiced its frustration and disappointment that a facility is not allowed to present additional information and/or its perspective about an incident, post survey, to DQA final decisionmakers about an incident that may rise to the level of an IJ deficiency.  We are pleased to announce that facilities will soon have the opportunity to do so.  DQA will be drafting an IJ decision meeting protocol early in 2024 that will provide a facility with a presentation opportunity.  We will provide membership with more details as we learn them.
    • WHCA/WiCAL will plan outreach to nursing home members about this new protocol once it is closer to finalization.

DQA also addressed provider association questions during the call. WHCA/WiCAL had submitted several questions, many of which will receive follow-up from DQA throughout the end of the year and into the new year, such as requests for IDR data and comprehensive 2023 survey data for Wisconsin and the nation.

WHCA/WiCAL asked DQA for any recent trends or patterns related to elopement. DQA shared that a review of elopement citations pointed to a concern of ineffective systems to prevent elopement, including:

• • • Door alarms shut off
    • Door alarms malfunctioned
      • Don’t wait till a system malfunctions: plan preventative maintenance
    • No root cause analysis of elopements conducted regularly
    • Residents know code to the door alarms

DQA recommended mock drills – having someone walk out with the alarms and see how long it takes someone to check to see if someone had left the building.

The LTC Ombudsman pointed out, as noted above about consistent staffing, that another reason to have consistent staffing is so staff know the habits of residents which can help reduce elopement if a particular resident is prone to wandering.

The next nursing home meeting between DQA and LTC provider associations is scheduled for Thursday, February 14.