August 2006
Form 2567: How to read this very important document
When scouting nursing homes for a family member or another person, one of the best things you can do is get and read each
home's Form 2567. It's the state inspection report for the facility, frequently called the state survey, and by law it must
be "readily accessible" to residents and visitors. You will typically find the document near the front desk in the lobby,
often in a binder labeled "state survey." If you don't find it, take a look around and see whether it's hanging on a wall.
Regular surveys are conducted every 12 to 15 months by state inspectors on behalf of the federal Centers for Medicare & Medicaid
Services.
If you can't find the survey, ask for it. If it's not readily available, that may mean the facility is hiding damaging information. When you do get it, sit down and read it carefully. Sometimes a nursing home will make a copy for you to take home. A lengthy inspection report usually reveals numerous problems at a facility. But keep in mind that a short one with few citations doesn't necessarily indicate that the nursing home is in great shape. It could just mean that state inspectors aren't looking very hard.
Here are the most important things to look for in the survey report:
RESIDENT ASSESSMENTS
Nursing homes are required to assess each newly arrived resident's physical, social, emotional, and mental condition. Under federal law, they must devise a comprehensive care plan within seven days after completing the assessment. Unfortunately, that is often not done. In the three most recent state surveys we analyzed for all nursing homes in the country, 6,012 homes received at least one citation for not developing appropriate care plans. On the Form 2567 you may find evidence that care plans are not being developed. If you place a relative in a facility that fails to write care plans or doesn't revise them as a resident's condition changes, that's a bad sign. It's an indication that you will have to ask about care plans and monitor the situation to be sure the facility's staff members follow the plan. Often they don't.
QUALITY OF CARE
If your family member is not properly cared for, serious injury or death can be the result. The Form 2567 often describes serious lapses in providing good care. Look for indications of problems such as doctors' orders that were not followed, laboratory tests that were not done, soiled linens that were not changed, and so forth. In this section of the report, you might find evidence of medication errors, which are common at nursing homes. In our survey analysis, 1,836 facilities received at least one citation for medication errors. Sometimes they are described in a separate section.
DIETARY SERVICES
While food service might seem to be a minor issue, it is not. Food is important to nursing home residents, and most residents look forward to mealtimes. It's not uncommon for facilities to skimp on snacks, which residents also enjoy. If you find that a facility you are considering is not providing snacks, that could mean a general lack of concern for the residents' little pleasures in life. Also look for evidence of unsanitary food practices that can breed infections.
PHARMACY SERVICES
If the survey notes problems, such as improperly labeling or storing pharmaceuticals or using expired medications, that could mean the facility is lax in monitoring the medications it gives to residents.
INFECTION CONTROL
Infections, particularly those of the urinary tract, are common among nursing home residents. If the report describes residents who have developed urinary tract infections, you should ask more questions of the facility's administrator. Why did they get them? Were residents allowed to lie in their own wastes too long? How many residents needed to go to the hospital for treatment resulting from such an infection?
Also see if the survey indicates whether residents have been denied flu shots or the pneumococcal vaccine, sometimes called Pneumovax. All residents should be receiving these inoculations. Note whether residents have been screened for tuberculosis, which is highly contagious among people living in close quarters. If residents have not been screened for TB or have not been offered a pneumonia vaccination within the last five years, as required by law, that again may indicate lazy care.
QUALITY OF LIFE
The Form 2567 may provide clues as to whether the home is providing activities or otherwise helping residents enjoy a better quality of life. Here little things matter, such as not giving residents a cup of coffee when they ask for one or making them go to bed early when they prefer to stay up late.
SOCIAL SERVICES
The federal nursing home reform law passed in 1987 requires that homes provide medically related social services to help each resident "attain or maintain the highest practicable physical, mental, and psychosocial well-being." Many times nursing homes don't do that. On the state survey, you might find that a facility has not provided dental care, a growing problem in nursing homes. Or you might learn that residents were not given assistance with eating or other activities of daily living.
ENVIRONMENT
Look for examples of mops and brooms left around or of other obstacles that could cause falls. That indicates carelessness on the part of the facility. Also look for lapses in routine maintenance, such as dirt, broken plumbing, peeling paint, laundry strewn about, or a strong odor of urine. The state of a nursing home's housekeeping says a lot about the facility.
COMPLAINT SURVEYS
As you examine the Form 2567 for the nursing home, look specifically for complaint surveys, which are reports generated by the state based on a complaint, typically made by a resident or a resident's relative. If a complaint survey or several surveys were completed after the date of the regular inspection, check to see what triggered the complaint. If the complaint involves a problem similar to one detailed in the previous regular inspection, that may mean the facility has not cleaned up its act or has failed to follow the plan of correction described in the regular inspection survey. That is a bad sign and should make you think twice before placing a family member there.
PLANS OF CORRECTION
The Form 2567 notes how the facility says it plans to correct each deficiency that inspectors have listed. If you find that the same problem persists, consider it a warning that the nursing home may not have not been serious about addressing the problem.
If you can't find the survey, ask for it. If it's not readily available, that may mean the facility is hiding damaging information. When you do get it, sit down and read it carefully. Sometimes a nursing home will make a copy for you to take home. A lengthy inspection report usually reveals numerous problems at a facility. But keep in mind that a short one with few citations doesn't necessarily indicate that the nursing home is in great shape. It could just mean that state inspectors aren't looking very hard.
Here are the most important things to look for in the survey report:
RESIDENT ASSESSMENTS
Nursing homes are required to assess each newly arrived resident's physical, social, emotional, and mental condition. Under federal law, they must devise a comprehensive care plan within seven days after completing the assessment. Unfortunately, that is often not done. In the three most recent state surveys we analyzed for all nursing homes in the country, 6,012 homes received at least one citation for not developing appropriate care plans. On the Form 2567 you may find evidence that care plans are not being developed. If you place a relative in a facility that fails to write care plans or doesn't revise them as a resident's condition changes, that's a bad sign. It's an indication that you will have to ask about care plans and monitor the situation to be sure the facility's staff members follow the plan. Often they don't.
QUALITY OF CARE
If your family member is not properly cared for, serious injury or death can be the result. The Form 2567 often describes serious lapses in providing good care. Look for indications of problems such as doctors' orders that were not followed, laboratory tests that were not done, soiled linens that were not changed, and so forth. In this section of the report, you might find evidence of medication errors, which are common at nursing homes. In our survey analysis, 1,836 facilities received at least one citation for medication errors. Sometimes they are described in a separate section.
DIETARY SERVICES
While food service might seem to be a minor issue, it is not. Food is important to nursing home residents, and most residents look forward to mealtimes. It's not uncommon for facilities to skimp on snacks, which residents also enjoy. If you find that a facility you are considering is not providing snacks, that could mean a general lack of concern for the residents' little pleasures in life. Also look for evidence of unsanitary food practices that can breed infections.
PHARMACY SERVICES
If the survey notes problems, such as improperly labeling or storing pharmaceuticals or using expired medications, that could mean the facility is lax in monitoring the medications it gives to residents.
INFECTION CONTROL
Infections, particularly those of the urinary tract, are common among nursing home residents. If the report describes residents who have developed urinary tract infections, you should ask more questions of the facility's administrator. Why did they get them? Were residents allowed to lie in their own wastes too long? How many residents needed to go to the hospital for treatment resulting from such an infection?
Also see if the survey indicates whether residents have been denied flu shots or the pneumococcal vaccine, sometimes called Pneumovax. All residents should be receiving these inoculations. Note whether residents have been screened for tuberculosis, which is highly contagious among people living in close quarters. If residents have not been screened for TB or have not been offered a pneumonia vaccination within the last five years, as required by law, that again may indicate lazy care.
QUALITY OF LIFE
The Form 2567 may provide clues as to whether the home is providing activities or otherwise helping residents enjoy a better quality of life. Here little things matter, such as not giving residents a cup of coffee when they ask for one or making them go to bed early when they prefer to stay up late.
SOCIAL SERVICES
The federal nursing home reform law passed in 1987 requires that homes provide medically related social services to help each resident "attain or maintain the highest practicable physical, mental, and psychosocial well-being." Many times nursing homes don't do that. On the state survey, you might find that a facility has not provided dental care, a growing problem in nursing homes. Or you might learn that residents were not given assistance with eating or other activities of daily living.
ENVIRONMENT
Look for examples of mops and brooms left around or of other obstacles that could cause falls. That indicates carelessness on the part of the facility. Also look for lapses in routine maintenance, such as dirt, broken plumbing, peeling paint, laundry strewn about, or a strong odor of urine. The state of a nursing home's housekeeping says a lot about the facility.
COMPLAINT SURVEYS
As you examine the Form 2567 for the nursing home, look specifically for complaint surveys, which are reports generated by the state based on a complaint, typically made by a resident or a resident's relative. If a complaint survey or several surveys were completed after the date of the regular inspection, check to see what triggered the complaint. If the complaint involves a problem similar to one detailed in the previous regular inspection, that may mean the facility has not cleaned up its act or has failed to follow the plan of correction described in the regular inspection survey. That is a bad sign and should make you think twice before placing a family member there.
PLANS OF CORRECTION
The Form 2567 notes how the facility says it plans to correct each deficiency that inspectors have listed. If you find that the same problem persists, consider it a warning that the nursing home may not have not been serious about addressing the problem.
