The Social Service Role in the State Survey

The annual state survey is a source of stress and anxiety for the staff in many long-term care facilities. The social worker often feels unsure of his or her role and avoids the surveyors as much as possible for fear of bothering them or exposing some problem they may not otherwise notice. Knowing what your responsibilities are and how to interact successfully with the survey team can make the inspection a more positive experience for everyone.

The social worker’s specific responsibilities will vary depending on the policies and practices of your facility. Check with your administrator to find out what is expected of you. In many facilities, the social worker prepares and updates the list of interviewable residents. The social worker may also be responsible for Resident Council or Family Council/Support Group. The minutes should be up to date, and concerns should be addressed with a written plan of resolution. If the social worker is responsible for the complaint/grievance file, this should also contain timely resolution of concerns. Many facilities seem hesitant to put family or resident concerns in writing for fear of raising “red flags”. The reality is, every facility deals with complaints. It can only benefit you in the survey process if you can show that you are addressing the complaints in a timely and meaningful manner. Also, if you have residents or families who are chronic complainers for minor incidents, the surveyors are likely to meet up with these people in the interview process. If you have a long list of complaints from them in your grievance file and have done your best to resolve them, the surveyors are likely to be much more understanding.

The following tasks should be done on an ongoing basis, but if you have fallen behind, they are areas to focus on when a survey is due. Documentation should be complete and up to date. The office should be organized and free of clutter (bags of deceased residents’ clothes or lost items can indicate that appropriate follow-up is not occurring). Social services, perhaps along with medical records, should ensure that each resident chart includes appropriate notification of resident rights, advance directives, acknowledgement of advocacy information and POA’s /guardianships. Residents, responsible parties and roommates should have been notified of roommate changes. There should be some process to show how residents and responsible parties are invited to care plan conferences. Behavior management and psychoactive dose reduction programs should be functional. Clothing, dental, visual and hearing aide needs should be met or in process.

High-risk residents with special needs should always be a focus, but this is certainly a good time to review the treatment and services being provided to ensure that everything possible is being done and is up to date. Residents with aggressive or other harmful behaviors and those on numerous psychoactive medications should be reviewed for possible revision of behavior plans, changes in meds or follow-up with mental health professionals. When a survey is imminent, the social worker may want to conduct resident and family interviews to identify and resolve any unknown grievances (consider using the interview guidelines from the long-term care survey manual). Daily action rounds can also be performed to help identify resident right and dignity issues. Being prepared in all of these areas will ensure your confidence when the surveyors review your work or ask you questions. However, dealing with the surveyors can be very daunting to inexperienced social workers. Here are some ways for you (and all of the staff) to successfully interact with the surveyor:

• Introduce yourself to the survey team and ask if they have any questions for you.
• Volunteer to assist the team during their tour.
• Introduce the survey team to residents, families and staff.
• Report to the surveyors the facility services or practices that have made a positive difference for residents.
• Take action to remedy any problems observed during the tour and throughout their visit.
• If the surveyor identifies a problem, ask for recommendations or possible solutions on the spot and be grateful when you get them.
• Know where to instantly find your policies, grievances, office documentation, QA information, etc.
• Explain any out-of-the-ordinary circumstances that might cause a problem they have identified, but do not make flimsy excuses.
• Be honest but smart about your answers. Do not agree with negative comments about resident care.
• Do not point out problem areas; let them find them on their own.
• Do not be defensive or argue with the surveyor.
• Be flexible in attitude.
• Feel comfortable telling a surveyor that you are busy (with a group, resident interview, family meeting, etc.) and will get back to them. They know resident needs come first.
• Be respectful and accommodating.
• Know the regulations that apply to you, and know them extremely well.

Take the initiative to share some of this information with your administrator to see how you can become more involved in helping to make the survey process a positive experience. It’s a chance for you to show off your hard work and learn how to provide better services for your residents in the future.

Reference: “The Social Service Role in Maintaining OBRA Psychosocial Requirements”, Dec. 2003, Sheryl Ludeke-Smith, MA, and Cross Country University.

Lori Ammon, LSW
Social Work Consultant