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The Activity Director's Office
Current Activities in Longterm Care
Kate Lynch, Editor
Music: "On the Sunny Side of the Street" furnished by Heart and Soul Music "Providing Quality Music for Nursing Homes"
The following is a brief summary of much longer articles from our recent issue about an area
that's of huge interest in the AD profession: the new Activities Guidelines and Psychosocial
Subscribers can read the entire articles in our current issue. And there's more to come, including
several articles about what may be required with the new guidelines from well-known
consultants, plus early readings on what's being expected with the initial surveys.

Senator wants tougher nursing home surveys, compliance
Two reports critical of CMS enforcement:
Will this have an impact on the new CMS activities surveyor guidelines?
(Reprinted from Current Activities in Longterm Care, July/August 06)

Sen. Chuck Grassley (R. Ia.) has some ideas that may help clarify the situation.
Grassley is clearly very unhappy, in general, with the way nursing home compliance surveys are
being conducted.
And he recently wrote a letter to the Centers for Medicare and Medicaid Services (CMS)
strongly suggesting that they need to toughen their surveys,  and increase enforcement of
And when Sen. Grassley speaks, the CMS will most likely listen.              
Reason: He’s chairman of the Senate Committee on Finance… one of the most powerful
positions in Congress, and is the person who sits on the purse strings of many agencies,
including the CMS.

Questionable surveys
And he’s not at all happy with the findings in a recent General Accounting Office (GAO) report on
nursing home conditions, surveys and compliance.

In his letter to the CMS, Grassley mentioned several items in that report that he was not at all
happy about.

For example, Grassley told about one instance of a long-time surveyor reporting that often
the findings in surveyors’ reports are “toned down, and even removed by the state director of
long-term care.”  And that there is ongoing “tampering with surveyor reports.”
He also said there were “serious inconsistencies in the results of state surveys, the continual
understating of negative findings, and an imbalance in the effectiveness of CMS oversight

“It is evident that there is questionable data resulting from state surveys in terms of both its
accuracy and consistency,” Grassley wrote.
“Often, the information is understated, misconstrued, or just plain untrue.”

Make them really random
Also, Grassley wants to make sure that random surveyor visits are truly “random.”
“‘Random’ nursing home surveys are many times not random at all,” he wrote. “The level of
predictability of these visits are sometimes all too predictable and this permits nursing home
staff to conceal instances of poor quality care.

“Please provide a detailed description of current CMS initiatives aimed at resolving this problem
and the improvements that you have documented resulting from any such initiatives.”

Toughening activities surveys?
It remains to be seen how much impact the Grassley initiative will have on the new activities
guidelines, but it could be substantial.
There are a great deal of directives in those guidelines, and areas of effectiveness and
accountability, that perhaps many AD’s are not used to dealing with, or don’t have the staffing
resources to effectively accomplish.
But a strict CMS compliance could be highly beneficial to these programs, relative to increased
budgets, better equipment and facilities, and improved quality-of-life issues for the elders.
Alzheimer’s Care Guide, and its associate publication Current Activities in Longterm Care, will
keep you informed as this very important situation continues rolling out of the offices in

Inspector General report
And still another recently-issued report brings even more pressure on nursing homes to comply
with survey results.   
The Office of Inspector General, of the Department of Health and Human Services, has issued
a report that says enforcement of nursing home non-compliance to the Centers for Medicare
and Medicaid Services (CMS) safety and health regulations is inadequate, and needs

Current CMS regulations require that CMS terminate their contract with the nursing home, or
deny payment for new admissions (DPNA) within certain time frames if deficiencies are not
The report states that “CMS is required to terminate nursing homes that fail to return to
‘substantial compliance’ within 6 months, or have unabated immediate jeopardy deficiencies for
23 days.”
The report states that CMS contracts should have been terminated at 55 nursing homes
between 2000 and 2002, due to noncompliance with health and safety regulations, but the
contracts were not terminated in 30 of those cases.
The report also stated that, of 706 cases requiring denial of payment for new admissions
(DPNA) in 2002, due to deficiencies at the residence, 28 percent were never applied, and 14
percent were applied late, due to late referrals of cases by state survey agencies.
In some cases, the report said, states did not enforce the regulations, as required by federal
law, because they were reluctant to displace the residents.  
However, inspector General investigators stated in their report that the deadlines for compliance
are not flexible, regardless of the reasons.
“The 6-month termination requirement is statutory,” said the report, “and the 23-day
termination is in current regulation.”

Grassley said the findings show a lack of proper enforcement of nursing home regulations by
the CMS.
“Residents in immediate jeopardy at a nursing home need to be somewhere safer,” the Senator
“Termination has to be real and enforced, or troubled nursing homes may have no other
incentive to clean up their act.”
“CMS should ensure that facilities facing termination either reach compliance or are terminated
within required time frames,” the report states, as well as requiring “stronger adherence” by
states in meeting required reporting deadlines.
The CMS responded to the report by saying that the agency has made “significant
improvements” in enforcement since the 2000-2002 period that the report covered, and is
working with nursing homes to improve their response to deficiencies.

Subscribers to Current Activities in Longterm Care can get the full text of Sen. Grassley’s
letter, plus the GAO report, plus the Inspector General’s report, online at
http://www.   Order Now for only $49.00!!
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