On-Site Ombudsmen Lead to More Skilled Nursing Deficiencies on Surveys

When an ombudsman remains on site during post-acute and long-term care facility surveys, the building’s quality scores may be negatively affected, according to a study in published this week in JAMDA, journal of AMDA — The Society for Post-Acute and Long-Term Care Medicine.

Researchers determined that ombudsmen may direct assessors to more attention to on-site problems, muddying the waters of quality ratings.

The role of an ombudsman is to be an impartial mediator and resident advocate to help assure the quality of a resident’s stay. Authors Diane Berish, Josh Bornstein, and John Bowblis looked closely at the ombudsman’s presence at the time of surveys and found that quality of life and administrative ratings were lower while deficiencies increased as compared to when an ombudsman was not on site.

Ombudsmen were present for almost 30% of visits, although that figure varied considerably from state to state: Massachusetts had the highest proportion, with one on site for 82% of facilities, while New Hampshire and Kansas brought up the rear with 0.8% and 1.5%. In addition, the officials were most often found on lower-rated sites during the time of surveys, the authors found.

The researchers’ analysis indicated that when present, a “0.2 increase in the number of deficiencies and 2.2-point increase in deficiencies occurred in the survey, which corresponds to a 3.9% and 5.9% increase” in problems associated with quality of life and administrative issues, according to the study.

More specifically, on a national level, an on-site ombudsman increased the number of deficiencies by 6.5% and increased deficiency scores by 11.3%.

Although the study contends that ombudsmen may alert surveyors to more problems, it’s possible that their presence may prompt the implementation of improvements based on poor findings — at least in the future.

“It may be the case that the presence of ombudsmen leads to long-run quality improvements. Ombudsmen present during surveys may have a better understanding of the facility-specific survey process, which they can use throughout the year to help their facilities address quality concerns,” said the authors.