Senior
evaluators Ryan Langrill and Tony Grange told the Joint Legislative
Oversight Committee on Monday that their investigators had uncovered
“serious dysfunction” within the Bureau of Facilities Standards, a
subsection of the Department of Health and Welfare which conducts
surveys of nursing home residents. Surveyors who worked in the office
had high turnover rates, and in both 2015 and 2017 only seven of 13
positions were filled. The current vacancy rate is more than 50 percent,
according to OPE’s report.
“Nursing
home surveyors described the workplace at the division as hostile and
demeaning,” the report states. “Surveyors feel berated and belittled;
they also believe the work environment explains the ongoing retention
problems of the survey team.”
While the Office of Performance
Evaluations staff didn’t find evidence that work environment had led to
excess fines against nursing homes, they found nursing homes were felt
intentionally targeted by bureau staff. Fewer than one in 10 nursing
home administrators said they had a high or moderate level of confidence
in the nursing home study team, compared to about 45 percent who
expressed confidence in the assisted living team and nearly 80 percent
in the children’s residential care survey team.
“Our
interviews and results from a questionnaire revealed that providers
fear and distrust the nursing home survey team,” the report states.
“Surveyors reported that individuals on the team intentionally instill
this fear.”
The bureau’s
workplace issues were so severe that OPE investigators asked to be
authorized to perform a follow-up investigation within three months,
both to ensure that employees who had cooperated with evaluators didn’t
face retaliation and to ensure that problems were quickly resolved.
“Correcting the workplace culture is the most pressing of our recommendations,” Langrill told the committee.
In
an official response attached to the report, Department of Health and
Welfare Director Russ Barron — who the report indicates began an
investigation once informed of the problems in the workplace — said the
department is committed to resolving the issues.
“We
find it unacceptable that despite our efforts over the last two years,
surveyors and nursing home providers feel the work environment and
culture continue to be harsh,” he wrote in an attached letter.
“We are currently conducting a workplace assessment to determine strategies to address the work environment and culture.
“We are currently conducting a workplace assessment to determine strategies to address the work environment and culture.
“We will resolve these issues.”
The
report also put focus on the diminishing number of facilities willing
to accept patients with complex behavioral and medical conditions, given
the lower and relatively flat reimbursement structure they receive from
the state.
Idaho’s Medicaid
program has a flatter reimbursement system than surrounding states, and
OPE found this has had the effect of reducing the number of facilities
willing to accept those with complicated behavioral issues.
“Hospitals, residential care providers,
and advocates reported to us and to the Legislature that placement in
residential facilities is more difficult for individuals with complex
medical conditions or behavioral problems,” the report states. “They may
remain in hospitals or move out of state to receive appropriate care.”
“Why
do we have essentially a flat reimbursement rate, regardless of the
complexity of the (patient’s condition)?” asked Chairman Mat Erpelding, a
Boise Democrat.
“It’s just the fee structure that the states have chosen to use. Idaho has less variation,” Langrill said.
One issue that OPE found was problematic
in the regulatory oversight of assisted living facilities is a
secondary class of violations called “noncore violations.” There is no
process to appeal a finding that a facility had violated those rules,
evaluators pointed out.
Lawmakers
and Barron lauded the report, and authorized the agency to follow up on
the employment issues over the next three months. It will produce a
follow-up reporton other issues in residential care regulation in a
year.
Rep. Maxine Bell, a
Jerome Republican and longtime chairwoman of the Joint Finance
Appropriations Committee, said the report underlined the need to restore
funding at the Department of Health and Welfare, which was cut during
the Great Recession.
“You cannot sit back and assume that a state agency can do more with less all the time,” she said.
“You cannot sit back and assume that a state agency can do more with less all the time,” she said.
Full Article & Source:
Evaluators find problems in nursing home oversight
It's in every state but thus far no state has really gotten serious to fix it.
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