Having an ombudsman linked with lower nursing home deficiency scores

October 28, 2019

UNIVERSITY PARK, Pa. — Nursing homes that have an ombudsman present for deficiency evaluations tend to have more deficiency citations and lower deficiency scores than nursing homes that do not, according to new research.

Diane Berish, assistant nursing research professor, said the study — recently published in the Journal of the American Medical Director’s Association — has important implications for nursing homes.

“The annual survey process is a high-stake event for nursing homes and one of the main methods states use to ensure that standards of care are met,” Berish said. “It's important that the survey process is conducted consistently, but there are possible sources of variability, one of which is the presence of an ombudsman during the survey process. There is no standard policy around whether ombudsmen should be present during surveys at facilities in their caseload and the way the Ombudsman Program operates varies from state to state.”

Berish investigated whether the presence of an ombudsman — typically a volunteer advocate who helps address issues of poor administration or violation of rights, specifically for residents of nursing homes, board and care homes, and assisted living facilities — had a significant impact on the outcome and consistency of a nursing home’s annual survey. They are often assigned a caseload of facilities to help mediate issues that are reported to them and are supervised by regional or state ombudsmen.

The Ombudsman Program was created to increase community presence in long-term care facilities and is an important part of residential care. Since then, their presence has become more common, specifically during annual state nursing home deficiency evaluations.

Each year, all 50 U.S. states conduct mandatory nursing home standard quality evaluations to assess the quality of care provided to its residents. These evaluations, also referred to as surveys, can have consequences for nursing homes depending on whether their facility meets state regulatory standards.

If nursing homes do not meet federal regulatory standards, they will be issued citations which can include monetary fines and lower Medicaid reimbursement rates. Receiving multiple citations can ultimately hurt the nursing home’s bottom line and its ability to invest in quality improvement for the facility, such as increasing staff or updated technology. The citations can also be used as a tool for litigation as an indicator of poor quality in malpractice lawsuits.

Using secondary data analysis and extraction of information from existing sources, Berish and her team determined that having an ombudsman present for the annual surveys did, in fact, have a negative effect on the nursing homes’ survey outcome — increasing the average number of deficiencies identified, with most issues relating to quality of life and administration deficiencies.

“The Long-Term Care Ombudsman Program is an important part of the long-term care system, and nursing home administrators should work their local ombudsman to help identify and resolve issues outside of the annual survey,” Berish said. “Additionally, surveyors should be aware of potential sources of variability, including the presence or absence of an ombudsman, and strive to conduct the process as consistently as possible from facility to facility.”

Future research could explore the ombudsman’s role during the survey process in greater depth. Researchers will conduct site visits and qualitative interviews with all stakeholders, which would help shed light on when and how ombudsmen contribute during surveys.

John Bowblis, a Miami University economics professor, and Josh Bornstein, a former Miami University undergraduate student in the College of Economics, also participated in this work.

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Brooke Killmon

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Last Updated November 19, 2019