LeadingAge NY and other associations representing nursing homes and adult care facilities (ACFs) met with the Department of Health (DOH) last week in a bimonthly provider association meeting.

Emergency Management

Heidi Hayes, Director of the Center for Long-Term Care Survey and Operations in the DOH Office of Aging and Long-Term Care (OALTC), addressed the work that the Department has been carrying out to connect with nursing homes in severe weather emergencies. The Department reminds facilities of storms and other emergency issues and touches base to help manage situations or concerns. They pointed out that facility contact information is sometimes inaccurate in the Health Commerce System (HCS). After-hours numbers should be updated. Facilities should ensure that this information is accurate in the system. A Dear Administrator Letter (DAL) on HCS contacts is available here.

Attendees suggested that DOH be clear and communicate directly with facilities, perhaps through a brief recorded webinar, in light of the significant turnover of administration and staff.

Grievance Process

As we have shared prior, DOH has been looking at the complaints received for both ACFs and nursing homes and notes that the number of complaints has grown significantly in recent years. While we have shared reasons we think may contribute to the trends, we share this information with members to help you understand the Department’s perspective and focus.

This recent discussion focused on nursing home complaints, though they will be sharing more information regarding ACF complaints in the future. In DOH’s review of nursing home complaints, it was felt that many of the issues ideally should have been resolved at the facility level. Thus, they encouraged nursing homes to ensure that residents and their loved ones are knowledgeable about how to address their grievances, and that the facility be active in addressing their concerns.

DOH also notes that certain facilities have a large volume of complaints that remain unresolved. DOH is unable to share the identity of those nursing homes. The Department will do a four-year lookback at those facilities with the highest volume of open grievances. Currently, 43 facilities have 30 percent of their grievances still open. DOH will collaborate to improve the complaint resolution process at the facility level. The goal is for residents to see issues resolved at the facility level on a more timely basis than the formal DOH complaint process. DOH will zero in on outlier facilities to try to understand the root problems. They will also look at resident council meetings and grievance logs. DOH indicates that this process will not be punitive, but collaborative. It will also help reduce the burden at the Department and facility level.

The Department is developing some long-term goals to help all facilities handle complaints more efficiently and effectively. Ashley Cokgoren, Deputy Director of the Division of Nursing Homes and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) Surveillance, stated that good grievance programs have a lot of grievances, and facilities are documenting and resolving those grievances.

Attendees asked the Department to drill down to the entity/person making complaints. DOH will be sure to look at bed numbers and capacity when determining outliers, as a higher number of complaints are expected at larger facilities. Some attendees stated that some residents insist that complaints be sent to the State. Sometimes it is indicative of a resident culture/staff hesitancy to push back.

Some are concerned that this issue will end up in the survey process. DOH is looking at this already, but may have a focused survey approach for outliers. One attendee stated that some complaints increased during COVID, and complaints affect quality measures and have financial and operational implications for facilities. The Department stated that 10 percent of backlogged complaints are from the pandemic time period.

The Department stated that residents need to have trust in facility staff to resolve issues. Turnover is a factor that impedes complaint resolution. DOH is not looking to change the survey process and invites input regarding any additional education that we think may be needed.

The Department is also monitoring ACF complaints and will provide more data. They recently shared that the highest ACF complaints were generally related to quality of care, physical environment, resident rights, and dietary issues.

Infection Control Drupal Audits

The Department provided an update on the nursing home infection control audits. This process is moving forward and going well. They received questions and are working to address them. The Department stated that the audits are looking good. 

Contact: Meg Everett, meverett@leadingageny.org, 518-867-8871