CMS Clarifies Interpretation of Abuse/Neglect Citations
On May 21, 2018, LeadingAge NY met by phone with the Centers for Medicare and Medicaid Services (CMS) to discuss citations related to abuse and neglect and how actions or inactions of individual employees impact nursing homes' potential to be cited. The meeting, which was requested by LeadingAge NY, was the result of concerns expressed by members that had been cited for abuse/neglect even though the circumstances surrounding the cited incident were solely attributable to individual culpability and not to the facility’s failure to ensure proper screening, training, policies and procedures, reporting, and actions against perpetrators.
Following the meeting, CMS provided some examples of case law that had formed the foundation of the guidance on the citation of F600 and the facility/individual culpability issue. During the May 21st meeting, CMS did clarify some issues and at the request of LeadingAge NY has provided the following written guidance, which we are distributing to members:
Thank you for your correspondence related to citations of abuse and neglect under Tag F600. In your letter, you request that CMS would further clarify in writing that there is a distinction between citations of abuse and citations of neglect under F600, including the circumstances under which a neglect citation would be unwarranted versus being appropriate, including further examples.
Tag F600 is composed of two main components- abuse and neglect. The Interpretive Guidance describes the following types of abuse: physical abuse, mental and verbal abuse, sexual abuse, and the deprivation of goods and services. More specifically, the deprivation of goods and services includes cases where an individual caretaker has the knowledge and ability to provide care and services, but chooses not to do it, or acknowledge the request for assistance from a resident(s), which result in care deficits to a resident(s). The severity level examples at F600 illustrate this type of noncompliance.
While the definition of neglect is similar to the description of the “deprivation of goods and services,” CMS has instructed surveyors to identify neglect as the facility’s failure to provide the required structures and processes in order to meet the needs of one or more residents. Noncompliance at a Quality of Care or Quality of Life tag alone does not indicate noncompliance at F600, unless the survey team can identify structure or process failures.
For example, a survey team identifies that a facility had failed to perform a skin assessment for a resident, resulting in failure to implement interventions to prevent the development of an avoidable pressure ulcer for a resident. Upon further investigation, the survey team finds that the facility identified weaknesses in staff performance and remedied them and oversaw and monitored care processes, including the provision of initial and ongoing assessments. In the absence of evidence of structure or process failures, surveyors would not cite neglect.
In circumstances where a staff member makes a mistake or otherwise exercises poor judgment, while noncompliance at the quality of care or quality of life tag may be identified, it may not be considered to be neglect unless the facility fails to take action to provide supervision and monitoring of staff, resulting in negative outcome(s) to the resident(s).
Thank you again for raising these concerns. I do appreciate our ongoing dialogue related to the nursing home requirements, in considering how to better protect the health and safety of residents. Please don’t hesitate to let us know if you need further clarification.
Contact: Elliott Frost, efrost@leadingageny.org, 518-867-8832