Reforming nursing home quality regulation. Impact on cited deficiencies and nursing home outcomes

The federally-mandated nursing home survey and certification process has been criticized for focusing more on the potential of each facility to provide good care than on the demonstrated quality of care delivered or on resultant resident outcomes. This paper presents the results of an evaluation of the pilot of a new federal survey process (Patient Care and Services, PaCS) that concentrates surveyor time on the review of resident care, reduces surveyor time spent reviewing policy and procedures, and, for the first time, mandates personal interviews with a sample of facility residents. In Rhode Island, a randomized control design was used to evaluate the impact of the survey on both the number and type of deficiencies cited, as well as on resident outcomes at six month follow-up. The PaCS team cited significantly more deficiencies, in total, than the traditional survey team, and significantly more patient-oriented deficiencies. However, no significant differences in resident outcomes were found when comparing nursing homes in which PaCS was administered and nursing homes in which only the traditional survey was administered.