With the recent reinstatement of annual state licensure and certification surveys after a one-year hiatus due to COVID-19, skilled nursing facilities (SNFs) across the nation are preparing with an understanding that there will be a heightened focus on infection control. The recent rise in cases spurred by the delta variant only solidifies that notion. To learn how providers can best prepare, we talked to Polaris Group Consultants, a post-acute healthcare consulting company that has conducted over 100 mock surveys at SNFs in the past few months.
During a mock survey, a team of Polaris consultants will apply the same protocols, tasks, and quality indicators used by surveyors. They also include an exit interview and detailed report with potential infection control deficiency findings and detailed recommendations to assist in taking corrective action. The process can be very beneficial, as it helps SNFs identify risk areas, achieve compliance, and avoid monetary penalties.
Empowering Those on the Frontlines
One of Polaris Group’s immediate findings was that the role of the infection preventionist has become an increasingly important aspect of SNF leadership. According to Polaris Group’s Lisa Barringer, RN, Infection Preventionist, Board Certified, “Facility infection preventionists are truly managing the day-to-day issues related to infection control.” As such, it is important they have not only the tools to do their job but an atmosphere that empowers them to do so.
During one recent education session with a client’s infection preventionist, the team member related that she feels like she now has the support of the facility administrator when ensuring infection control policies are being followed. She stated, “Prior to the pandemic, I did staff observations and reported back to the director of nursing. Now, I take matters into my own hands when I see failures in staff compliance.”
Another infection preventionist related that she no longer hesitates to reach out to county, state, or federal entities when she has questions. She stated, “There is much more collaboration between the facility and the agencies. I know if I fail to understand a new or updated policy that comes out, it may mean life or death for my residents. This has motivated me to take my role much more seriously than ever before.”
Longer Visits, More Findings
With the increased infection control measures comes more tests, more time spent analyzing the SNF from top to bottom, and more possibilities for citations. Many SNFs are seeing substantial increases in the number of onsite days and the number of surveyors present. Often, survey teams combine the annual survey with multiple complaint follow-ups, further increasing the scrutiny. As a result, many of these extended surveys have resulted in multiple deficiencies.
SNFs that have experienced an annual survey in 2021 have seen an increase in observation of all types of resident/staff interactions by surveyors, including hand hygiene, the use of personal protective equipment (PPE), and compliance with proper mask wearing. Due to the heightened threat to resident health and safety due to COVID, it is imperative that nursing home staff adhere to fundamental health and safety protocols. Failure to do so will result in citations, even for seemingly low-level, isolated incidents.
Since March 2020, 29 SNFs have been cited with infection prevention and control deficiencies and 62% had financial penalties imposed, averaging approximately $65,600. “These rates of federal sanctions are notably high,” said Wendy Erickson, Senior Regulatory Consultant. It is no wonder, then, that Polaris Group has experienced a sharp uptick in SNFs proactively reaching out for assistance in preparing for the longer and more intensive state surveys.
Don’t Lose Sight of Pre-Pandemic Priorities
SNFs across the country are concerned that during the last year-and-a-half, the focus on infection control and keeping staff and residents healthy has taken precedence over managing the day-to-day issues that define the usual priorities. Concerns range from maintaining a successful fall prevention programs, preventing abuse and neglect, preventing unavoidable declines in activities of daily living (ADL), as well as managing pressure ulcers and weight loss.
“Data from Quality Certification and Oversight Reports indicate that this concern has merit, as the most frequently cited long-term care survey deficiencies thus far in 2021 are related to day-to-day routine issues,” Barringer pointed out. Clearly it is imperative that SNFs maintain focus on typical duties while also increasing focus on infection control. No small task, and prioritizing life-and-death issues over those that may seem minor is understandable. Nonetheless, SNFs that master this delicate balancing act will be rewarded once surveyors arrive.
Many clients also have shared with the Polaris Group consultants that they are seeing mass exodus by team members leaving healthcare due to the pressure of the new normal along with exceptionally stressful survey experiences. “This in turn creates more reliance on agency/interim staffing, which in some cases causes facility leadership additional issues related to noncompliance while placing an even greater financial burden on the facility,” Cynthia Wilkins, Senior Regulatory Consultant said.
During this challenging time for staff, it is important that leadership remained determined to keep morale up by showing appreciation to their staff. This can include not only financial rewards but social activities where employees can take a break from the day-to-day stress. “One large organization recently held a leadership conference for frontline staff in which there were various entertainment outings in addition to a focus on developing improved leadership skills,” Wilkins added.
Prepare the Emergency Plan
It only makes sense that during the largest crisis SNFs have ever faced, survey teams are taking a deeper dive into emergency preparedness plans. Many administrators voiced to Polaris Group that their emergency preparedness plan is scrutinized much closer now than during pre-pandemic surveys. “One nursing executive with a large continuing care retirement community stated that survey teams are looking much more in depth at overallemergency planning,with a special focus on both pandemic planning and planning for threats related to the region in which the community is located,” Wendy Strain, Director of Consulting Services, Senior Regulatory pointed out.
As long-term care industry leaders continue to find their way in this new norm that changes almost daily, the focus remains on providing quality care for residents. Despite the immense challenges, the industry has proved resilient and determined to move forward in a positive manner. COVID-19 is likely here to stay, and SNFs must adapt their day-to-day management tactics to continue to combat the virus while still focusing on the basics of resident care.
For more information on Polaris Group and its mock surveys contact Polaris Group at 800-275-6252 or https://www.polaris-group.com/