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Surviving an Inspection

September 1, 2003
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Expert advice from an experienced administrator BY STANLEY SPECTOR
Surviving an Inspection

This experienced administrator offers survey-survival tips for his hard-pressed colleagues

BY STANLEY SPECTOR Like every nursing facility in America that accepts Medicaid and/or Medicare reimbursement, we undergo a survey by the state department of health. And, like every facility, we work hard to achieve the best outcomes possible. It isn't easy, but we've done acceptably well and, for what it's worth, would offer some suggestions that might be of help to our colleagues nationwide. To begin, review your survey from the previous year and any other state reports you might have received between the last year's survey and the present date. Remember, any complaints, abuse investigations, and focused reviews may affect your site visit.

The state survey team gets a schedule from the central office and plans an unannounced visit. You must be prepared every day for an unannounced visit. By the same token, you have to strike a balance. It is better to have satisfied customers, i.e., residents and families who will keep an operation solvent, than to have a perfect survey with low occupancy.

So, how do you maintain a balance and survive?

First, some facts of life: In today's arena, the state and federal governments are pressured to enforce the letter of the law when it comes to inspections of nursing facilities. The administrator always sets the tone and the priorities for the organization. He/she must be aware of any problems, know the pulse of the staff and the residents, and keep abreast of the regulations. His/her relationship with the ownership, whether for-profit or nonprofit, must be a good fit. It is said that a successful administrator must know which buttons to push and exactly when to do so. In the last analysis, the ownership or board of directors must allow the administrator to function.

The administrator should meet with all staff on a quarterly basis to give updates, review problems, and provide the face-to-face leadership that the staff requires. On a daily basis, while it is always easier to manage by memo or by delegation, I have found another way:
  • Spend part of the day on the units talking to staff and residents.
  • Greet families and ask how everything is going.
  • Plan events that involve many staff.
  • Elicit cooperation and ideas from residents and staff.
  • Schedule and attend all morning reports.
  • Let the staff discuss ideas and help them to shape a conclusion.
  • Have an open-door policy.
  • Use resident and family satisfaction questionnaires on a regular basis.
  • Be visible at mealtimes.
  • Administer by example, when necessary.
  • Review all incidents and accidents as soon as possible to prevent future occurrence.
  • Assist department heads to be successful by suggesting specific solutions and methods.
  • Plan for new projects and equipment in consultation with the appropriate departments.
  • Do not make unilateral decisions. They don't work.
  • Discipline, but always end on a positive note.
  • Operate the facility with consistency, seven days a week.
  • Include yourself as the administrator for full-day weekend and holiday coverage as part of the rotation with department heads.
  • Always have the nursing supervisor or director of nursing call you when the fire alarm is activated, there is a death on the premises, a major disruption of staff or services occurs, or a government official has appeared on the premises.

The professional administrator in 2003 must be cognizant of not only the finan-cial side, but the clinical side, as well. When there is a deficiency, the adminis-trator is held responsible-he/she cannot pass the blame on to a department head.

There is no question that it takes great commitment and a lot of time to comply with the regulations, keep the beds filled, and ensure that staff are properly trained and supervised. I would sum up with the following advice:

  • Be dedicated to the profession and to the residents.
  • Recognize that this is not a 9-to-5 job with weekends off.
  • Never delegate something that could affect your personal future and license.
  • Get involved in professional development of your staff.
  • Look with your own eyes.

And, finally, always remember, "My strength comes through the strength of others." NH


Stanley Spector is administrator of the Promenade Rehabilitation and Health Care Center, Rockaway Park, New York. For further information, phone (718) 945-4600 or fax (718) 634-8237. To comment on this article, e-mail spector0903@nursinghomesmagazine.com.
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