MedlineUniversity.com Understanding the Importance of the CNA in QIS Understanding the Importance of the CNA in QIS
To obtain a Medline University CE credit, you must complete these activities:
1) Read through the entire continuing education course
2) Take a post-test with a proficiency score of at least 70%
You will be prompted at the end of the course with a certification credit. This continuing
education course is sponsored by Medline Industries Inc.
Course Objectives
There are three objectives for this continuing education course. Upon completion of this
one hour course, learners will understand how the state survey process evolved over
the years into the new Quality Indicator Survey and the role of the CNA in quality care
understand the particular importance of the Certified Nursing Assistant in QIS and
resident-centered care.
Secondly, we’ll learn more about the Quality Indicator Survey process and explore the
different aspects of the resident interview, resident observations and family interviews in
Stage 1 of the Quality Indicator Survey.
And lastly, learners will be able to list examples of how the CNA can help improve the
quality of care in long-term care facilities overall.
Objective #1
Let’s start with the first objective of this course, which is to understand how the state
survey process has evolved into the new Quality Indicator Survey and the role of the
CNA in quality care.
To understand both QIS and the important role of the CNA, we’ll need to step back and
review how the traditional state survey process evolved over the years.
CMS Sets the Standards for Nursing Homes
The Centers for Medicare & Medicaid Services or CMS sets the standards for nursing
homes that provide services CMS beneficiaries. These beneficiaries are the women and
men that nurses and certified nursing assistants provide care to every day in long-term
care facilities across the United States.1
Page 1 of 17 MedlineUniversity.com Understanding the Importance of the CNA in QIS As you know, working in conjunction with CMS, state survey agencies send out
surveyors once per year to nursing homes to make sure that the residents who live
there are being treated properly and in accordance with federal guidelines.
These federal guidelines set the standard for critical aspects of resident care, covering a
wide range from care plans, dressing and bathing, dispensing medication to the
cleanliness of the facility.
CMS Recently Revised its Survey Process
To improve the way that it measures adherence to its guidelines, CMS recently revised
its survey process. The new survey process took CMS over 15 years to develop. It’s
called the Quality Indicator Survey or QIS.
The name says a lot about this particular survey because QIS looks at numerous
indicators that a nursing home and its staff are providing quality care. CMS believes that
by examining these indicators, it can better understand what it’s like to live at a nursing
home, and whether the care provided meets its guidelines.
Currently, there are over 4,000 federal and state surveyors, who conduct on-site
reviews of every nursing home.2 CMS is training these surveyors, and as they’re trained
QIS will become the state survey of record throughout the United States, Puerto Rico
and the U.S. Virgin Islands.
CNAs Play a Crucial Role in Quality Care
As you know, the CNA plays a crucial role in quality care. That’s because CNAs often
perform the activities and actions that mean the most to nursing home residents and
their quality of life. Things like their overall treatment, oral care, when they wake up,
their dressing, bathing and grooming, incontinence care and many other aspects of their
care.
And when problems arise, it’s usually the CNA who notices the issue first and reports it
to their supervisor or floor nurse. It’s hard to imagine a facility that could exist without
the care and diligence that CNAs provide.
However, it wasn’t until 1987, that the specific role and training of the CNA became a
part of the federal regulations that govern nursing homes.
CMS Had Long-Standing Concerns with Quality in Nursing Homes
CMS had long-standing concerns with quality in nursing homes. In the mid-1980s, as an
example, consumer complaints and feedback to regulatory agencies started to surface
and point to a growing problem of inadequate care in nursing homes.
In a 1986 report called Improving the Quality of Care in Nursing Homes3, the Institute of
Medicine found widespread non-compliance with federal regulations.
Page 2 of 17 MedlineUniversity.com Understanding the Importance of the CNA in QIS The report made many recommendations, including asking for a stronger federal role in
the regulation of nursing homes. It also recommended introducing a new nursing home
inspection and certification process. The Institute of Medicine also suggested including
resident assessments as part of the survey process.4
The Nursing Home Reform Act
These suggestions along with input from numerous health professionals and legislators,
help spawn the Nursing Home Reform Act of 1987.5
Signed into law by President Ronald Reagan, this landmark legislation introduced
numerous changes to how quality of care would be practiced and monitored in nursing
home.
It also required that any long term care facility receiving Medicare or Medicaid funding
needed to ensure that nursing home residents could attain their highest level of practical
physical, mental and psychosocial well-being.
This law was significant in that it recognized that a nursing home was not only a place
where elderly people received medical care, but it was always their home.
The Omnibus Budget Reconciliation Act of 1987 (OBRA ’87)
The Nursing Home Reform Act was a part of a large and comprehensive legislation
called the Omnibus Budget Reconciliation Act of 1987 or OBRA ’87.
OBRA ’87 established a uniform set of standards for nursing homes to follow and
brought about important changes to nursing home care.
It also imposed sanctions for those nursing homes that failed to meet requirements.
These sanctions included monetary fines and the refusal to reimburse nursing homes
for new admissions until they corrected their performance.
Most importantly, it launched the state survey process, and called for state agencies to
do unannounced surveys. These surveys were required to take place at least every 15
months but usually happen once per year.
OBRA ’87 Addressed Quality of Care Issues
It specifically set numerous new and important guidelines, such as resident evaluation
upon admission, the development of individual care plans for residents, the reduction of
unnecessary and inappropriate physical restraints and staffing requirements.6 Most of
the policies in place at the nursing home that you work at today resulted from the OBRA
‘87 legislation.
In terms of the staffing requirements, OBRA required nursing homes to hire a registered
nurse as their director of nursing and ensure that licensed practical nurses were on staff
24 hours a day, 7 days per week.
Page 3 of 17 MedlineUniversity.com Understanding the Importance of the CNA in QIS It also set standards for the training and certification of certified nursing assistants.
Previously, CNA training and certification were not covered by federal law, but
regulators realized the CNA were responsible for delivering the majority of care that
nursing home residents received.
New Standards for CNAs
Federal regulators enacted new standards for CNAs to ensure that these care givers
were adequately trained. They understood the importance of the CNA as front-line care
givers in the delivery of quality care and ensuring quality of life for residents in nursing
homes.
Typically, CNAs must hold a high school diploma or Government Equivalency Diploma
in addition to the required training and exams. OBRA also requires that certified nursing
assistants undergo a minimum of 75 hours of training and pass a competency test to
working a nursing home.7
And in addition their certification and on-the-job training, CNAs typically take 12 hours of
training each year to keep their skills fresh and understanding of regulations up to date
through courses like this one.
The Day in the Life of a CNA
The day in the life of a CNA is not easy, but very rewarding. Congress and CMS
understood that without the CNA, providing quality care to older persons, who reside in
long-term care facilities, would not be possible. Although called nursing assistants by
title, the CNA main role is to assist the residents.
Every day, CNAs provide vital services like bathing and dressing the resident, helping
the resident in and out of bed, taking vital signs for pulse, blood pressure and/or
temperature.
Additionally, if there is medical change in the resident’s status, the CNA is typically the
first staff member to notice and report critical changes in emotion, behavior or condition
of residents under their care.
Let’s review what we’ve learned thus far.
Quality Indicator Survey
Although OBRA ’87 accomplished many important goals, 10 years later, concerns
continued to surface about the quality of care in nursing homes.
As a result of these concerns, CMS began looking at how to ensure and better measure
the quality care through annual state surveys. The result of about 15 years of
comprehensive research is the Quality Indicator Survey.
Page 4 of 17 MedlineUniversity.com Understanding the Importance of the CNA in QIS The Quality Indicator Survey or QIS is based on the same federal guidelines as
traditional state surveys. The Federal regulations and interpretative guidelines instituted
by CMS have not changed, including the staffing requirements for nurses and CNAs.
But QIS replaces traditional state surveys as the state survey or record, as each state
trains its surveyors in the QIS process.
What is different is the way in which a QIS survey is conducted by state surveyors, the
depth of issues covered and its emphasis on resident-centered care. QIS examines
over 50 care areas and over 160 quality indicators to help CMS and state agencies
make sure that everyone who works in a nursing home stays on track.
QIS Measures Compliance
QIS measures compliance against the same federal guidelines as traditional state
surveys.
But QIS is more highly structured than previous surveys, and it’s also a computerassisted, systematic process. It has two stages similar to a traditional state survey, but
because surveyors use a computer to help guide them, they are able to cover aspects
of the federal regulation in a more consistent and structured manner.
QIS was designed to achieve several objectives.8 CMS hopes to improve the accuracy
and consistency of state surveys with QIS. For this reason, QIS is highly structured and
each surveyor documents their results in their computer. CMS hopes these changes will
enhance documentation and help it to focus its resources on the largest number of
quality concerns.
QIS Rollout
QIS is currently being rolled out on a national basis. You may hear nursing home
administrators and professionals referring to themselves as QIS and non-QIS states. All
50 states, as well as the U.S. Virgin Islands and Puerto Rico will participate in QIS,
meaning they will utilize it as their state survey of record and they will equip and train all
their state surveyors in how to conduct a QIS survey.
Starting in 2007, numerous states have begun implementing the Quality Indicator
Survey, including Connecticut, Kansas, Ohio, Louisiana, Florida, Minnesota, North
Carolina, New Mexico, West Virginia, Maryland and Washington.9
These states are in various stages of rolling out and implementing QIS. Connecticut, for
example, was the first state to fully train its state surveyors in QIS and implement QIS to
all of its nursing homes.
Page 5 of 17 MedlineUniversity.com Understanding the Importance of the CNA in QIS CMS Plans to Implement QIS in Bands
CMS plans to implement QIS in small bands of five to seven states. As surveyors are
trained in QIS, the states will shift to QIS as the state survey of record.
In the map above, you will see a green band of states which represents the first
implementation band for QIS, consisting of five states: Delaware, Maine, Vermont,
Maine and Arizona. The first three states—Delaware, Maine and Vermont—began state
surveyor training the summer of 2009. The last two states in the first band—Georgia
and Arizona—are scheduled for training in the winter of 2010.
The second band of QIS states are represented in yellow. The next training band
includes the six states of Colorado, Nebraska, Indiana, Oregon, Utah and New York and
the District of Columbia. Training for band two is slated to begin as early as summer
2010.
Page 6 of 17 MedlineUniversity.com Understanding the Importance of the CNA in QIS Review Questions:
1) How often is the state survey conducted?
a. Typically once per year
b. It varies from state to state
c. When time permits
d. Every four years
2) Who signed the Nursing Home Reform Act into law?
a. A local congress member
b. It was never passed
c. Ronald Reagan
d. George Washington
3) Which of these were addressed in the Omnibus Budget Reconciliation Act of 1987?
a. Monetary fines
b. Staffing Requirements
c. CNA training
d. All of the above
4) A day in the life of a Certified Nursing Assistant might involve which activities?
a. Bating residents
b. Waking residents
c. Taking vital signs
d. All of the above
5) Which of following statements is not true?
a. Federal regulators understand the importance of CNAs as front-line care givers
b. CNAs do not effect quality initiatives
c. CNAs play an important role in providing quality care to nursing home residents
d. The work that CNAs do every day is critical to meeting regulatory guidelines
6) How does CMS plan on rolling out QIS?
a. Once its completed QIS
b. On Mondays
c. In bands
d. There are no current roll out plans
Page 7 of 17 MedlineUniversity.com Understanding the Importance of the CNA in QIS Objective #2
You’ve now learned about the concerns that prompted Congress and CMS to reevaluate how state surveys were being done. You’ve also learned how the state survey
process evolved into the Quality Indicator Survey and the importance of the CNA in
providing quality care.
In this next section of this continuing education course, we’ll learn more about the
Quality Indicator Survey process and explore the different aspects of the resident
interview, resident observations and family interviews in Stage 1 of the Quality Indicator
Survey.
Quality Indicator Survey
The Quality Indicator Survey is designed to measure the care that the nursing home
resident typically receives every day. CMS would ideally like to see its certified nursing
homes and their staff offering care that is resident-centered and helps residents to
achieve their highest level of well-being.
As a consequent, CMS incorporated the resident’s perspective into the QIS process.
Resident interviews occur in Stage 1 of QIS. Not only are residents interviewed during
this stage, family and staff interviews also occur in Stage 1. During this first stage,
surveyors also look at how well the nursing home is providing care against numerous
care areas and quality indicators.
Let’s take a closer look at the QIS Survey.
Care Areas & Quality Indicators
As we learned earlier, QIS examines over 50 different care areas and over 160 quality
indicators to help CMS and state agencies make sure that everyone who works in a
nursing home stays on track in the delivery of high quality care and meeting federal
guidelines.
Care Areas are an important part of QIS. These care areas stem from different aspects
of CMS federal regulations. Care Areas reflect many critical components of nursing
home care, aspects of resident life and things that must done or put in place to provide
high quality. Some examples of Care Areas are Activities, Dignity, Dental, Environment
(including the building, room and furnishings), Choices and Abuse.
Quality Indicators help CMS gauge whether a nursing home and its staff are adequately
adhering to its guidelines. Quality Indicators indicate whether the Care Area is being
met.
Page 8 of 17 MedlineUniversity.com Understanding the Importance of the CNA in QIS Environment Care Area
For example, in the Environment Care Area, surveyors will observe things like whether
residents have clean linens available to them, whether they have a functioning call
system and whether the resident has the proper safety equipment in their bedroom and
bathroom.
In addition to making observations about different care areas, surveyors will also directly
ask or interview residents.
For the Environment Care Area, surveyors will ask residents if their building is a
comfortable one in which to live and also if their facility is a clean facility. These are both
examples of indicators, which will help surveyors determine what it’s like to live in the
facility where you, as a CNA, work.
Stage 1 of QIS
In Stage 1 of QIS, several important things are accomplished.
Using the QIS computer, surveyors select residents who will participate in the survey.
Surveyors will interview and observe these residents, and they will also interview family
members of some residents and interview staff members.
These three sets of interviews and observations are done to ensure that the care that is
required and documented is similar to the perception of care received by the residents
themselves and observed by the resident’s friends and/or family members. Typically,
CNAs are not interviewed during QIS.
Unlike previous survey methods, in QIS, all of the people interviewed—residents, family
members and staff—are asked the identical set of questions regardless of what state
they live in or who administers the survey.
Second, in addition to interviewing and observing residents, family and staff members,
surveyors will also examine a number of issues having to do with how the facility is run.
These issues are called Facility-Level Tasks.
In each Quality Indicator Survey, the surveyors will examine six different aspects of the
facility, such as the dining room, food service, infection control, demand billing, the
quality assessment process and the resident council.
Stage 1 also includes a review of records and MDS data.
After all these activities are completed, results are tabulated on to a Tablet PC that each
QIS surveyor uses during the survey. The results determine whether there are issues
that surveyors will want to further examine in Stage II of QIS.
Page 9 of 17 MedlineUniversity.com Understanding the Importance of the CNA in QIS Stage 2 of QIS
With QIS, unlike traditional state surveys, many aspects of QIS, like resident samples,
resident, family and staff interviews and mandated facility-level tasks, are driven by a
structured process.
The surveyors will enter all their data from interviews with residents and family
members, observations and chart reviews into their Tablet PCs. After entering this data,
they’ll determine what to investigate in Stage 2 of the survey.
If they discover concerns with how the residents are treated, these concerns will trigger
further investigation and may result in deficiencies or F-tags for the facility.
As a CNA, you can help ensure that your facility performs well by providing residentcentered, quality care every day.
Environment Care Area
For example, in the Environment Care Area, surveyors will observe things like whether
residents have clean linens available to them, whether they have a functioning call
system or whether the resident has the proper safety equipment in their bedroom and
bathroom.
In addition to making observations about different care areas, surveyors will also directly
ask or interview residents.
For the Environment Care Area, surveyors will interview residents and ask if their
building is a comfortable one in which to live, and also if their facility is a clean facility.
These are both examples of indicators, which will help surveyors determine what its like
to live in the facility where you, as a CNA, work.
Resident Interviews are Critical
Resident interviews are critical to QIS, which relies on direct feedback from residents to
determine if care is being properly administered. During the first part of QIS, you’ll
notice a number of interviews being conducted with residents and their family members.
After the surveyor has explained the purpose of the interview and obtained the
permission of the resident, the interview process will begin.
The interview is designed to help surveyors understand what it’s like to like in the
nursing home. And as such, the surveyor will conduct the interview in a private setting
to allow the resident to speak freely.10
The surveyors will also take a Tablet PC computer with them during the interview. Each
surveyor uses a Tablet PC, which contains all the questions that they intend to ask and
it’s also used to store the answers. Each resident is asked the same questions.
Page 10 of 17 MedlineUniversity.com Understanding the Importance of the CNA in QIS Cognitive and Non-Cognitive Residents
However, some residents may not be able to participate in the interview process. In
your experiences as a certified nursing assistant, you’ve encountered both cognitive
and non-cognitive residents.
Surveyors will interview current residents, though some that they have selected will not
be able to participate due to their cognitive status. To determine cognitive status, the
surveyor will ask several questions. Non-cognitive residents are those that are unable to
answer basic questions about their life in the facility.
For non-cognitive residents, state surveyors will interview family members, guardians or
friends. The surveyor will ask family members many questions. For example, does the
facility provide the resident with what they would like to eat or drink? The surveyor also
will ask about staff assistance: Does the staff provide the resident with assistance when
needed?
Resident Observations
In addition to interviews, Resident Observations are another critical piece of QIS for
both cognitive and non-cognitive residents. Surveyors will also observe non-cognitive
residents and look for the telltale signs of neglect or good care, whatever the case may
be. They will observe the resident themselves and their living area to determine if the
resident is well-cared for at the nursing home.
They’ll want to view the resident’s room to determine if it’s in good order, meaning that
its properly equipped, maintained and cleaned.
Some observational indicators include unclean skin, matted eyes, signs of incontinence
such as odor or wetness, skin problems like tears, bruises or burns, and soiled bed
linens.
What Goes On During the Resident Interview?
You may be wondering, what goes on during the Resident Interview? Each resident
interview will vary in how long it takes to complete, but typically interviews will take
between 30 minutes and one hour. If the interview ends sooner, or if the surveyor
returns to a resident for a second interview, don’t be alarmed.
If a resident is unable to answer the questions because of their cognitive state, the
surveyor may discontinue the interview. Surveyors may return to finish an interview, if
the resident has a scheduled activity or becomes fatigued.
The interviews cover a wide range of topics from resident choices about their bedtime to
whether the resident has access to their personal funds account. The answers to each
of the questions will help indicate whether quality care is being provided in accordance
with CMS guidelines.
Page 11 of 17 MedlineUniversity.com Understanding the Importance of the CNA in QIS Choices Care Area
Let’s review some of the questions that will come up in the resident interviews.
The Resident Interviews typically start out with several questions about the Choices
Care Area. Specially, the surveyor will want to determine if the resident is making
choices in certain areas of their daily life. They’ll want to know if the resident is making
decisions regarding food choices or preferences, choosing their bedtime and choosing
when to get up, and if they are choosing their dressing and bathing schedule.
Each resident interviewed will able asked about these specific aspects of life in the
nursing home to get an indication of whether the criteria for the Choices Care Area is
being met.11
Choices
For many individuals, making these types of decisions or choices is important to some
resident’s psychosocial well-being, which we learned about earlier. However, for some
residents, making these types of choices is not particularly important.
For this reason, the surveyor will also ask residents who do not participate in making
choices, Is this acceptable to you?
QIS has been called a more resident-focused survey process in part because surveyors
not only interview residents about their life in nursing homes but also try to determine
what is most important to the residents themselves.
Dignity
Dignity is another care area reviewed during the resident interview in a QIS survey. In
the interview, the surveyor will ask the resident if the staff treats them with respect and
dignity.
Respect and dignity may be difficult concepts for some to understand. The focus of this
question is to determine how well the staff interacts with the resident.
For example, the surveyor may ask? Does the staff take the time to listen to you? Is the
staff helpful when you request assistance?
To understand this care area better think of your own experiences. When care givers
listen to you and help you when you require assistance, does that help you to feel
respected?
Oral Health
Now, let’s review another important care area that’s part of QIS, Oral Health. According
to the Department of Health and Human Services, about 5 percent of residents at longterm care facilities have problems receiving dental adequate care.12
Page 12 of 17 MedlineUniversity.com Understanding the Importance of the CNA in QIS To understand this care area better, the surveyor will ask the resident about different
aspects of their oral health, like whether or not they experience mouth or facial pain or if
they have chewing or eating problems.
The surveyor will ask the resident specifically; Does the staff help you—as necessary—
to clean your teeth? Some individuals will not need help with daily brushing and dental
care, but for those who do need help, the surveyor will want to know if aid is provided.
The surveyor will also ask the resident, How often are your teeth, dentures or mouth
cleaned? And whether that’s done on a daily, weekly or monthly basis or not at all.
Abuse
Lastly, let’s cover one of the most important quality indicators examined by surveyors—
Abuse.
Rightly so, CMS and state regulators take abuse of individuals who live in long-term
care facilities very serious. And accordingly, abuse indications will trigger a Stage 2
investigation.
The surveyor will ask the resident, Have you ever been treated roughly by staff?
The surveyor will also observe both cognitive and non-cognitive residents to see if the
staff treats residents in a manner that may indicate abuse. Some indications include
yelling at the resident, striking a resident or treating a resident in a rough manner.
Abuse Defined
CMS defines ‘Abuse’ as the willful infliction of injury, unreasonable confinement,
intimidation, or punishment with resulting physical harm, pain or mental anguish.13
Depriving an individual of goods or services that are necessary to attain or maintain
physical, mental or psychosocial well-being falls under the category of abuse.
CMS requires that all alleged (or potential) violations involving mistreatment or neglect
be reported immediately.
Let’s review what we’ve learned in the second section of this continuing education
course.
Page 13 of 17 MedlineUniversity.com Understanding the Importance of the CNA in QIS Let’s review what we’ve learned thus far:
1) Interviews are an important part of the QIS process?
a. False
b. True
2) Which groups are interviewed in a QIS survey?
a. Residents
b. Family members of residents
c. Staff
d. All of the above
3) What of the following statements is false about the QIS process?
a. Surveyors will ask residents about the weather
b. It is a two-staged process
c. State surveyors will ask residents about their bed time
d. State surveyors will interview family members of residents
4) In what was are QIS and the traditional state survey similar?
a. Both refer to the same federal guidelines and interpretive guidance
b. Both focus on measuring quality of care
c. Both types of surveys are supervised by state and federal regulators
d. All of the above
5) Which of the following statements is false?
a. All residents are reviewed during QIS
b. Surveyors will only interview cognitive residents
c. Surveyors will conduct interviews in private
d. Surveyors will not review non-cognitive residents
Page 14 of 17 MedlineUniversity.com Understanding the Importance of the CNA in QIS 6) What types of things might a surveyor observe under the Environment Care Area?
a. The cleanliness of the facility
b. Call Systems
c. Available of proper safety equipment
d. All of the above
Objective #3
Let’s move on to the last objective of this course, which is to help you as a certified
nursing assistant identify three areas where you can provide high-quality and residentcentered care.
The CNA plays a vital role in providing quality care to nursing home residents. In this
next section, we will examine four areas that are part of CMS requirements for nursing
home staff and reviewed during the QIS process.
We’ll help you identify areas where the CNA can help provide better care that’s focused
on the resident’s individual needs.
Cleanliness & Grooming
As a CNA, one of your duties may involve helping the residents under your care to
dress and bath. When assisting the resident, help them comb their hair, keep fingernails
clean and trimmed and keep their glasses clean, if they wear them.
Regular bathing should help eliminate most unpleasant odors, however, if an odor
persists, report it to the floor nurse. It may be the result of another medical problem.
Oral Care
Oral care is an important part of grooming. If you notice broken or loose teeth, report
these to the floor nurse. In addition, help the resident clean their teeth, dentures or
mouth on a regular basis.
If you notice problems, such as mouth or facial pain when the resident is eating or
chewing, report these to the floor nurse as well.
Dignity
As we mentioned earlier, respect and dignity may be difficult concepts to understand.
It’s important that all staff members treat residents in a way that indicates a willingness
to help the individual thrive in their environment.
As you’re conducting your day-to-day tasks with a resident at your facility, make sure
that you take the time to listen to any requests or questions that they may have. Offer
assistance whenever possible.
Page 15 of 17 MedlineUniversity.com Understanding the Importance of the CNA in QIS Something else that you can do as a CNA is to help the residents dress in appropriate
clothing for the time of day and season. Also, make sure that they have the necessary
support surfaces to feel comfortable and provide them with privacy when needed.
Abuse
Lastly, one of the most important areas of the QIS survey and of providing care to
elderly people in long-term care facilities is to make sure that they do not suffer any
form of abuse.
Even one report of abuse will trigger further investigation under the QIS process or the
traditional survey process because it’s of critical important to CMS and your nursing
home administrator.
Remember to never treat residents roughly. Never yell at or speak to residents in harsh
or rude tone. And never cause physical harm by striking or mistreating a resident. This
includes depriving them of water, food or aids that they require for daily living.
If you notice rough or rude treatment by any members of the staff at your nursing home
facility, immediately report these concerns to the administrator at your facility.
Conclusion
We hope that this educational course will help you understand the Quality Indicator
Survey better and the role of the CNA in delivery resident-centered care.
To proceed, continue to the post-test exam. After completing the exam, you will need to
complete a Medline University exit survey.
1 Use of State Agencies to Determine Compliance by Providers of Services with Conditions of
Participation, Sec. 1864. [42 U.S.C. 1395aa], Social Security Act.
http://www.ssa.gov/OP_Home/ssact/title18/1864.htm
2 Action Plan for (Further Improvement of) Nursing Home Quality, Centers for Medicare and Medicaid
Policy, p. 2.
3 Committee on Nursing Home Regulation, Improving the Quality of Care in Nursing Homes, Institute of
Medicine. National Academic Press, Washington, DC, 1986, p. 2.
4 Ipid, p. 21.
5 Nursing Home Reform at of 1987.
6 Omnibus Budget Reconciliation Act of 1987 /P.L. 100-203, Approved December 22, 1987 (101 Stat.
1330). http://www.ssa.gov/OP_Home/comp2/F100-203.html
7 Ipid, OBRA ’87 CNA requirement.
Page 16 of 17 MedlineUniversity.com Understanding the Importance of the CNA in QIS 8 CMS Quality Indicator Survey, p.1.
9 CMS Priority Order Quality Indicator Survey (QIS) National Implementation in States Memo, Director
Survey and Certification Group, August 7, 2009. Ref: S&C-09-50.
10 Resident Interview, Quality Indicator Survey Procedures for Long-term Care Facilities, p. 20.
11 Index of Quality of Care Areas, CMS QIS (PDF).
12 Oral health in America: a report of the surgeon general. Rockville, MD: U.S. Department of Health and
Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health,
2000.
13 CMS Operations Manual, F223 & 225.
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