The results of a Kentucky nursing home’s inspection can either attract people to the facility or scare them off. Citations for abuse, negligence, and other indicators of low quality appear online now for anyone to see (thankfully). Who is it that conducts these inspections and writes the citations?

The Role of CMS

The Centers for Medicare & Medicaid Services (CMS) is the federal agency responsible for oversight of the Medicare and Medicaid programs. CMS operates within the Department of Health and Human Services DHHS). Much of the budget for Medicare and Medicaid programs is dedicated to nursing home care and services for the elderly and disabled.

Nursing homes that wish to provide services to Medicare and Medicaid recipients must meet certain minimum requirements, which were established by Congress and are outlined in the Social Security Act. The Secretary of DHHS is tasked with monitoring and enforcing the requirements. CMS produces regulations and manuals that set forth the details of the requirements.

Each state agrees—through a contract with CMS— to conduct inspections of the nursing homes that receive funds from CMS. Usually, the state’s department of human services or health department is responsible for performing the inspections. Inspections occur at least once a year, more often if the nursing home has had poor inspection reports.

What Attributes Are Evaluated?

An inspection covers several areas, including the following:

Health Inspection

  • Date of the last standard health inspection
  • An extremely detailed complaint survey, including dates and the names of residents and staff members involved
  • Health deficiencies in the following areas:
    • Quality care
    • Resident assessment
    • Pharmacy service
    • Environmental
  • Fire safety deficiencies in the following areas:
    • Smoke compartmentalization and control
    • Electrical

Staffing

Staff hours per resident per day for the following positions:

  • Registered nurses
  • Licensed practical nurses/licensed vocational nurses
  • Certified nursing assistants
  • Physical therapy staff

Quality Measures

Measures of health and well-being by percentage for short-stay residents

  • who self-report moderate to severe pain;
  • with new or worsening pressure ulcers;
  • who receive, appropriately, the seasonal flu vaccine;
  • who receive, appropriately, the pneumococcal vaccine; and
  • who newly receive an antipsychotic medication.

Measures of health and well-being by percentage for long-stay residents

  • who fall at least once with major injury;
  • with a urinary tract infection;
  • who self-report moderate to severe pain;
  • (high risk) with pressure ulcers;
  • (low risk) who lose control of their bowels or bladder;
  • who had a catheter inserted and left in their bladder;
  • who were physically restrained;
  • whose need for help with daily activities has increased;
  • who receive, appropriately, the seasonal flu vaccine;
  • who receive, appropriately, the pneumococcal vaccine;
  • who receive an antipsychotic medication;
  • who lose too much weight; and
  • who have symptoms of depression.

Has Your Loved One Been Injured In A Nursing Home?

If you believe your loved one is being subjected to nursing home abuse you need to speak with an experienced Kentucky nursing home neglect attorney as soon as possible. Contact us online or call our office directly at 888.450.4456 to schedule a free consultation.

Matthew L. White
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Founder & Partner of Louisville Personal Injury Law Firm Gray & White Law