Read two chapters and answer questions.

Chapter 5

Case

Conflict of Interest or Not?

Bestcare Nursing and Rehabilitation Center is a 290-bed dually-certified 4-story facility located in a large city (the average size of a nursing home in the United States is 108 beds, according to data from Health, United States 2012, published by the National Center for Health Statistics). The facility operates at 92% occupancy, and only 15% of the residents have a private source of payment. In the past, the facility has had quality of care issues in the areas of diets and nutrition; practices in food preparation that may lead to contamination that could cause sickness; proper storage and dispensing of medications; and inadequate number, variety, and quality of recreational programs. Mona Sinclair was the RN leading the survey team for Bestcare’s annual survey. Mona used to be an RN employed by Bestcare, but she left voluntarily 3 years ago for family reasons. Jonathan Husky, the dietitian on the survey team was a consultant on contract for Bestcare, but last year he did not renew his consultancy contract. An LPN on the survey team was discharged from Bestcare approximately 2½ years ago for excessive absenteeism. Another member of the survey team had her mother as a resident in Bestcare, but she moved to a different facility 6 months ago.

Questions

1.  What should be the composition of the survey team?

2.  Do the four individuals identified in the case have a conflict of interest? Explain. (To answer this question, you must review Section 7202 of the State Operations Manual, Chapter 7—Survey and Enforcement Process for Skilled Nursing Facilities and Nursing Facilities, available at http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/som107c07.pdf.)

Chapter6

For Further Thought   1.  A patient’s family visits a skilled nursing facility that is dually certified. The patient’s daughter meets with the administrator and inquires, “My mom, Josephine, has Medicare coverage. I am a nurse and have been taking care of her at home, but my family and a new job are putting more and more demands on my time and I cannot take care of my mom anymore. She requires tube feeding and has an indwelling urinary catheter. She is in a wheelchair because of limited mobility. She may need some physical therapy. I have heard good things about your nursing home and would like to bring her here.” What should be the administrator’s response?