A return to more “normal” nursing home operations in the post-pandemic world has also often meant a return to certain more serious citations, one industry expert pointed out last week. There has been a particular rise in those labeled as J or greater in scope or severity, which puts them into the Immediate Jeopardy category, she added.
Survey tags citing nursing homes for accident hazards, lack of supervision, and inappropriate or misused devices (F-689) continue to run high nationwide this year. The number of Immediate Jeopardy citations on pace to either meet or exceed 2023, expert analysis shows.
The data, collected and made publicly available by the Centers for Medicaid & Medicare Services, is also leveling out from spikes in COVID-related incidents due to isolation and infection control protocols, said Angie Szumlinski, director of Risk Management for Chelsea Rhone.
Last year, there were just 154 Immediate Jeopardy citations for infection control, involving 0.8% of surveyed facilities, per an analysis from Proactive LTC Consulting.
“They stopped doing infection control surveys so once they stopped those, I believe those numbers came down,” Szumlinski told McKnight’s Long-Term Care News on Tuesday. “It was also an easy one to cite.”
Meanwhile, CMS data for the 2023 calendar year shows a total of 6,115 F-689 tags, with 784 rated as Immediate Jeopardy. In calendar 2024 thus far, there have been a total of 2,990 F-689 citations with 406 classified as IJ.
The citations warrant an all-hands-on-deck response to understand why, said Denise Winzeler, Curriculum Development Specialist for the American Association of Post-Acute Care Nursing. The association posted on these tags recently, with insight from Szumlinski.
“I think it’s imperative that facility leaders remain diligent and review their incidents daily and identify the root cause of the issue,” Winzeler told McKnight’s on Wednesday. “Identifying the root cause and correcting that root cause with a sustainable intervention mitigates the risk not only for the resident that was involved but for any other residents that the same issue may affect in the future.”
‘Human’ effects overlooked
Choking risks and burn hazards are frequently overlooked, Szumlinski said. Facilities generally do a good job of assessing residents for the type of diet they need, but the human dynamic cannot be discounted, she added.
“They might have been fine yesterday and fine today to eat that burger, but tomorrow they may choke on ground beef,” she explained. “There needs to be constant observation and staff being alert to any changes (in a person’s condition) that might be missed. You need a nurse in the dining room of a skilled [nursing] building.”
Burns are another hazard that present unique challenges and need more attention.
“Environmental does a great job with water temperatures it shows, but dietary is really difficult,” Szumlinski said. “You have residents who don’t want cold or warm coffee or soup, or they may have tremors, Parkinson’s, or cognitive loss, and they spill things.”
Elopements were the top reason for the F-689 citations in 2023, but the majority of those events did not become adverse incidents because the residents were quickly located and brought back into the facility, noted Shelly Maffia, director of Regulatory Services for Proactive LTC Consulting.
Too many facilities don’t react in the proper way to these events, though.
“When you have a serious event occur that results in serious harm or the potential for serious harm or even death, facilities need to treat that as if they’re in Immediate Jeopardy,” Maffia told McKnight’s. “Too many facilities wait until a surveyor comes in and then they’re in trouble.”
Maffia’s analysis of 2023 Immediate Jeopardy citations suggests that facilities have good processes in place to identify and mitigate risks but they don’t factor in the human side of the equation, she said.
“They’re not always looking at the additional risk factors for each resident,” she said. “For elopements, for example, it could be someone who’s cognitively intact but is not adjusting well to the nursing home environment and they leave without staff knowledge or proper supervision. There are so many factors, including looking at [residents] as individuals and what puts them at risk. That’s patient-centered care.”
