Resident choice and the survey process: the need for standardized observation and transparency.
OBJECTIVE
To describe a standardized observation protocol to determine if nursing home (NH) staff offer choice to residents during 3 morning activities of daily living (ADL) and compare the observational data with deficiency statements cited by state survey staff.


METHODS
Morning ADL care was observed in 20 NHs in 5 states by research staff using a standardized observation protocol. The number of observations in which choice was not offered was documented for 3 morning ADL care activities and compared with deficiency statements made by surveyors.


RESULTS
Staff failed to offer choice during morning ADL care delivery for at least 1 of 3 ADL care activities in all 20 NHs. Observational data showed residents were not offered choice about when to get out of bed (11%), what to wear (25%), and breakfast dining location (39%). In comparison, survey staff issued only 2 deficiencies in all 20 NHs relevant to choice in the targeted ADL care activities, and neither deficiency was based on observational data.


CONCLUSIONS
Survey interpretative guidelines instruct surveyors to observe if residents are offered choice during daily care provision, but standardized observation protocols are not provided to surveyors to make this determination. The use of a standardized observation protocol in the survey process similar to that used by research staff in this study would improve the accuracy and transparency of the survey process.
Schnelle
John F
JF
Vanderbilt University Medical Center, 1161 21st Avenue South, S-1121 Medical Center North, Nashville, TN 37232-2400, USA. John.Schnelle@vanderbilt.edu
Bertrand
Rosanna
R
Hurd
Donna
D
White
Alan
A
Squires
David
D
Feuerberg
Marvin
M
Hickey
Kelly
K
Simmons
Sandra F
SF
D000203:Activities of Daily Living; D002755:Choice Behavior; D019538:Health Care Surveys / Q000379:methods; D006801:Humans; D009735:Nursing Homes; D019370:Observation; D018802:Patient-Centered Care; D011369:Professional-Patient Relations; D015203:Reproducibility of Results; D014481:United States