Introduction
The Westmount Health Facility in Queensbury, NY, has previously been cited for violating various federal nursing regulations. Violations refer to any inconsistencies in the practice of nurses or any other nursing home employees with regard to the standards of practice as espoused in the CMS Manual System. Disciplinary actions are taken against offenders in accordance with the standards to ensure compliance and reduce instances of violations. The following violations were identified to be against the CMS regulations as required in law as per the surveillance report and video case.
Case Study – Nursing Home Surveillance Report
Violation: Failure to Comply with Quality Care Requirements
Nursing homes are required to provide high-quality care to their residents by ensuring no forms of discrimination occur. In this case, the facility failed to conduct its operations in line with the requirements under the CMS regulations (DiNapol, 2016). As a result, the facility and the county were fined for this violation. The regulations that were violated included:
- 483.12(c) Equal Access to Quality Care
- 483.25 Quality of Care
- 483.15 Quality of Life
The above regulations are concerned with the quality of care provided to the residents to ensure their safety and improved health. Regulation 483.12(c) on equal access to quality care aims to deliver equality to all residents to receive services as per the State plans and guidelines (Centers for Medicare & Medicaid Services, 2006). Therefore, not considering their source of payment, all individuals must receive the same quality of care in nursing homes. Failure to adhere to this regulation leads to a violation of the resident’s rights.
Apart from that, nursing facilities are also supposed to ensure the quality of care provided for patients is up to the required standards as per regulation 483.25. This means that the health and overall wellbeing of the resident must improve, showing that the amount of assistance provided is beneficial to them. Consequently, any forms of deterioration not in line with the normal aging process or any other natural causes lead to a violation of this regulation. Lastly, the environment in the nursing home should be capable of maintaining or enhancing the quality of life of the resident as per regulation 483.15. It is, thus, the sole responsibility of the facility to ensure that they do not violate this condition by providing an environment that influences the patient’s life negatively.
Violation: Creating Immediate Jeopardy to Resident Health and Safety
Resident health and safety form an essential aspect in the role of nursing homes and can only be achieved if the facility puts in place measures to prevent any form of abuse. Any situations that jeopardize the well-being of the residents, thus, are in violation of federal and state laws (DiNapol, 2016). In this case, the facility was in violation of the following regulations:
- 483.13(b) Abuse
- 483.13(c) Staff Treatment of Residents
Any form of abuse affects the ability of a patient to have a high quality of life at the nursing home. Any form of treatment that interferes with the rights of the patients can be termed as abuse as per regulation 483.13(b) (Centers for Medicare & Medicaid Services, 2006). Furthermore, nursing homes must ensure that there are appropriate policies and procedures that guide the treatment of residents by staff and any other individuals. This is to guarantee that any form of mistreatment or neglect can be minimized as per regulation 483.13(c).
Violation: Failure to Make the Environment Free of Dangers that Cause Accidents
Nursing homes have residents with various medical conditions and age-related limitations that require constant supervision and an appropriate level of care in their environment. Singh (2014) states that “ fall-related injuries result in a substantial legal liability for the nursing facility, as well as pain, suffering, loss of function and death among residents (p. 291). The lack of adequate measures to protect such residents from immediate danger in their environment leads to a severe violation since it poses a danger to their lives (DiNapol, 2016). In this case, the nursing facility violated the following regulation:
- 483.70 Physical Environment
- 483.25(h) Accidents
- 483.75(m) Disaster and Emergency Preparedness
The physical environment is an essential factor since it covers the entire space through which the residents directly interact with themselves or others. The risk of danger compounds in instances where a resident may not be aware of their surroundings, thus increasing the possibility of hurting themselves or others. Consequently, regulations 483.70 and 483.25(h) on the physical environment provides for the measures to be undertaken by a nursing facility to protect its residents from unnecessary dangers in their environment (Centers for Medicare & Medicaid Services, 2006). The possible dangers include fire incidents, electrocution, or any accidents that may cause physical harm to the residents, as outlined in regulation 483.75(m).
Violation: Failure to be administered in Maintaining the Highest Possible Level of Wellbeing for each Resident
Administration determines the level of care provided and the ability of the facility to conduct its mandate. This begins with the nursing home leadership that is responsible for offering the right direction while having the appropriate staff to attend to residents. The facility subsequently violated the following regulation in this case:
483.75 Administration
Residents expect high-quality services in nursing homes that promote their overall well-being as they recover or cope with the effects of old age. As a result, the administration of such facilities must be top-notch to ensure that the services provided are up to both state and federal standards. More so, the staff employed at the facility must hold the appropriate qualifications, certifications and be licensed with the necessary bodies. This ensures that the decisions made are based on experience, and technical expertise, thus ensuring the maintenance of the high quality of life and care at the nursing home. Additionally, the facility’s leadership must also be accountable for their actions and be held responsible for any problems in the facility. Furthermore, making sure that all laws and regulations are appropriately adhered to will result in the best care for residents during their stay.
Violation: Failure to set up or Keep a Group of People to Review and Ensure Quality
Quality assurance is an essential factor in nursing homes since it reviews the level of care and services provided by the facility. In this case, a violation of the following regulation occurred:
483.75(o) Quality Assessment and Assurance
The lack of a quality assurance and monitoring team causes continued violations by the nursing facility since there are no appropriate measures to identify deficiencies and correct them on time. This necessitated the application of regulation 483.75(o) that requires a nursing facility to have a dedicated team to review and ensure quality (Centers for Medicare & Medicaid Services, 2006). Therefore, the facility continuously committed violations that affected the quality of services offered, leading to several citations.
Video Case
Violation: Medicare Fraud
Fraud goes against federal laws and is punishable by law with regard to the extent it occurs. Teitelbaum & Wilensky (2020) state that “unlike Medicaid and CHIP, state governments do not generally contribute to Medicare spending” (p. 259), meaning that it is the sole responsibility of the federal government. In this case, three individuals defrauded the taxpayer-funded Medicare program to a tune of $1 billion (Associated Press, 2016). In this case, the following regulations were violated:
- 483.20(i) Certification
- 483.20(j) Penalty for Falsification
- 483.75(l) Clinical Records
- 483.75(b) Compliance with Federal, State, and Local Laws and Professional Standards
Nursing homes are required to perform assessments on the resident to determine the appropriate level of care, after which such assessments are further submitted to the state in cases needing financial assistance. All individuals in the assessment are obligated to certify the authenticity of the information provided as per regulation 483.20(i). Additionally, falsification of such assessments leads to penalties as per regulation 483.20(j) (Centers for Medicare & Medicaid Services, 2006). Regulation 483.75(l) also requires the clinical records of patients to be correctly input and up to date for any review when necessary. The failure to follow these regulations led to the violations witnessed in this case that ultimately led to the defrauding of $1 billion from the Medicare program. This shows that the facility did not follow regulation 483.75(b) that sets the general set of procedures, laws, and standards to be followed in the running of the nursing facilities.
Conclusion
The violations witnessed in the Westmount Health Facility and other institutions as outlined in the Nursing Home Surveillance report outline the problems in these facilities. To prevent such continued occurrences, more surveillance should be undertaken regularly to identify facilities that continuously violate CMS regulations. This can enable the escalation of such cases and, where necessary, recommend their closure in instances where the lives of residents are in imminent danger. The above-mentioned federal regulations represent the most violated ones, hence more administrators must take the initiative to identify lapses in their facilities to reduce their occurrence.
References
Associated Press. (2016, July 22). $1b Medicare fraud nursing home scam, 3 charged [Video]. YouTube. Web.
Centers for Medicare & Medicaid Services. (2006). CMS manual system pub. 100-07 State operations provider certification – Transmittal 19. Web.
DiNapol, T. P. (2016). Nursing home surveillance – Report 2015-S-26. Division of State Government Accountability.
Singh, D. A. (2014). Effective management of long-term care facilities (3rd ed.). Jones & Bartlett Learning.
Teitelbaum, J. B., & Wilensky, S. E. (2020). Essentials of health policy and law (4th ed.). Jones & Bartlett Publishers.