The whole survey process is a joke. Administrators know when it’s coming; they beef up staffing, paint the walls and spray the halls with deoderizer. They harp and hoot and carry on like the stupid monkeys they can be- deamnding everyone be prefect and telling us what to do, how to act and what to say (and not say!)

Ask an aide and we’ll tell them: The truth is nursng homes suck. They are, as Kim has written here, borderline concentration camps where the resident is the very last person who is truly honored and cared about. Oh sure it’s bragged about- we passed the survery with 0 deficiencies! But that means nothing. 0 means poor care still happens; weight loss is still a factor; falls and bed sores still occur…resident to resident abuse can still be a problem. And of course staff to resident abuse can always be a factor with the best inspectiion results.

CMS minimum standards represent the least a facility can do in order to provide an acceptable level of care. The standards themselves are quite stringent because nursing homes have a long history of inadequate care. This problem is compounded by requiring administrators to be licensed. In my state, the training is required under state law to be conducted by the state nursing home association (which is a private lobbying organization/this is probably illegal but a topic for another discussion). The required textbook is James E Allen’s “Nursing Home Administration” which literally says the best way to manage CNAs is to keep them in their place. Administrators have never been taught anything else and no incentive to change their ways. Hospital administrators are not licensed and are hired on the basis of graduate education, membership/fellowship in the American College of Healthcare Executives, and their previous management experience. Nursing home administrators are hired on the basis of whether or not they have a license, which requires a 6 month internship after either a bachelors degree or an equivalent amount of time as a department head. If a hospital has a bad JCAHO survey, the administrator gets fired. If a nursing home has a bad survey, the administrator stays because the industry intentionally restricts the number of licensed administrators.