The Centers for Medicare & Medicaid Services (CMS) will expand its use of a targeted dementia care survey in fiscal year 2015 in Texas and other states, the agency relayed in a March 27 memo to state survey agency directors.
A focused dementia care survey, developed after discussions with “key stakeholders and experts,” was pilot-tested in 2014 in a total of 20 nursing homes in California, Minnesota, New York, Illinois and Louisiana. Between July and September, four surveys were completed in each state, with materials being revised based on feedback after initial visits were completed. The new surveyor worksheets and processes were used with the aim of more thoroughly examining nursing homes’ processes for prescribing antipsychotic medications and assessing compliance with other federal requirements related to dementia care. CMS says the pilot project helped it gain insights into surveyor knowledge, skills and attitudes as well as determine ways to streamline the surveying process so that successful and deficient dementia care programs could be recognized more efficiently and accurately, according to the agency.
Surveyors said that “the dementia care focused survey in its present form is time-intensive but yields valuable information that enabled the surveyors to better identify and cite deficient practice when compared to the standard annual or complaint surveys (either Traditional or Quality Indicator Survey (QIS)),” CMS consultant Alice Bonner, PhD, RN, an associate professor of nursing at Northeastern University, Boston, wrote in a final report on the 2014 pilot project. Most of the surveyors think that a more detailed evaluation of dementia care practices should be part of the annual survey process, she added, although most also belief that the focused survey could be conducted by itself at the discretion of the state agency or CMS. The 2015 test will study some of these suggestions.
This year’s project also will expand on last year’s efforts in an attempt to improve surveyor effectiveness in citing poor dementia care and the overuse of antipsychotic drugs. The surveys typically include three to four staff members visiting for 1.5 to 2 days. A CMS consultant accompanies each survey team on the initial visit, and state agency workers are trained via webinar beforehand and receive ongoing phone and email support.