Nursing Home Care

Key Facts (for 2000)

• Number of homes: 1,030
   
• Number of residents: 100,000
   
• Number of inspectors: 159
   
• Ohio Department of Health offices: Akron, Cambridge, Columbus, Dayton and Toledo
   
• Number of surveys (inspections): 2,678
   
• Complaints investigated: 1,585
   
• Complaint citations written: 1,050
   
• Total citations written (complaint and annual inspections): 6,810
   
• Percent of complaints in which citations are issued: 31 percent
   
• Top five citation categories: quality of care, supervision to prevent harm, preventing accidents, pressure (bed) sores, sanitary conditions/food preparation.
   
• Top three reasons nursing homes have conditions where there is an immediate threat to the health or safety of residents: elopement (a resident leaves the facility without anyone knowing); resident falls during transfer from a bed; medication errors.

While all long-term care facilities (nursing homes) in Ohio must be licensed by ODH to operate, the federal process known as certification is optional. Facilities that want to be reimbursed for providing care and treatment to Medicare and Medicaid-eligible individuals must be certified. The recommendation for certification follows a survey (inspection) by the Bureau of Long Term Care Quality, and the final decision is made by the regional office of the federal Centers for Medicare and Medicaid Services (CMS), previously known as the Health Care Financing Administration (HCFA).

ODH surveyors conduct surveys in long-term care facilities every nine to 15 months, as required by federal law, and federal surveyors conduct state oversight inspections of 5 percent of the long-term care facilities in Ohio every year. The federal surveys may also be used as a training tool for state inspectors.

All surveys of long term care facilities are unannounced.

In 1999, a federal initiative directed ODH to conduct at least 10 percent of all inspections during off hours (before 7 a.m., after 5 p.m. or on weekends.) Ohio has exceeded this goal by surveying 11.5 percent of facilities during off hours in 1999 and 14.5 percent during 2000.

Following a survey, facilities are issued a statement of deficiencies within 10 days if problems are cited. The purpose of this statement is to detail for the provider areas that are not in compliance with state or federal regulations. Each deficiency cited also includes the scope and severity to show the seriousness of any problems.

These survey documents are a public record and available to members of the public who want to see what type of compliance history a facility has. Facilities are required to post the most recent inspection report in an area accessible to residents, families and visitors, while ODH maintains at least three years of records that include annual and complaint inspections. The federal government also makes recent inspection reports available on the Internet at www.medicare.gov

The Complaint Process
All complaints against a nursing home are investigated by Ohio Department of Health surveyors. The complaint investigations are unannounced, so the nursing home does not have prior notice of an on-site visit. Anyone can file a complaint against a nursing home (residents, family members, visitors, facility staff) and the complaint may be filed either anonymously or confidentially. If filed confidentially, the complainant receives a letter updating them of the status of the investigation. The identity of a complainant is never revealed.

Each complaint is evaluated and prioritized, based on the seriousness of the allegation. Based on this determination, a complaint is assigned a two, 10 or 30-day time to investigate. Complaint investigations are scheduled based on the information provided in the complaint. For example, if an allegation is made that the nursing home is short staffed on the 11 p.m. to 7 a.m. shift on weekends, the investigation will be scheduled during that time period.

Nurse Aide Training
The Nurse Aide Training and Competency Evaluation Program (NATCEP) was established to comply with Omnibus Reconciliation Act (OBRA) 1987 requirements. Program functions and responsibilities include approving and providing direction to the "Training and Competency Evaluation" (TCE) program. The major responsibilities include: reviewing, evaluating and revising TCE guidelines, standards and rules to assure that hands-on staff follow state and federal regulations when providing care. These standards and guidelines require ongoing revision to meet federal and state requirements for providing care. Staff provide technical assistance to providers and consumers.

There are more than 500 TCE programs and 16 train-thetrainer programs in Ohio. The training programs conduct desk audits of program operations and changes to assure quality of care requirements are met. This unit also oversees both the written competency evaluation and the clinical skills competency evaluation for every nurse aide employed in a long term care facility in Ohio. Approximately 12,000 prospective nurse aides are tested each year and the Ohio Nurse Aide Registry currently has approximately 102,000 entries listed.

Technical Assistance Program (TAP)
Ohio is in the process of implementing House Bill 403, which created a Technical Assistance Program (TAP) to be administered by the Bureau of Long Term Quality in the Ohio Department of Health. The mission of TAP is to improve the quality of care and life for people in nursing homes in Ohio.

The TAP's initial goal is to determine what can be done to assist facilities in improving outcomes related to dermal pressure ulcers (DPUs), also known as bed sores. While many of the procedural details of how TAP will work are still being developed, there are some functions and activities which will be implemented in the near future.

Current data show that nearly 12,000 residents in Ohio nursing homes have pressure sores, the majority of which are preventable. It is a key strategic management goal of the Bureau of Long Term Care Quality to reduce the prevalence of pressure sores in Ohio nursing homes by the year 2002. As this program is developed and implemented, the Ohio Department of Health Web site will keep all interested parties informed of the progress.

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Last Updated: 08/21/2001