Survey collaboration was among the topics on the agenda at a recent Wisconsin Department of Health Services (DHS) Bureau of Assisted Living (BAL) forum, where department leaders, frontline surveyors and an assisted living provider shared updates designed to improve the survey process.

The initiatives grew out of statewide conversations held last year with both providers and surveyors. BAL Deputy Bureau Director Kathy Teske said the feedback gathered through that process shaped all three initiatives, which focus on electronic records access, shared expectations for providers and surveyors, and a forthcoming survey readiness publication.

Electronic Records Access

A central focus of the survey collaboration discussion was the push to increase electronic records access during surveys. Teske noted that delays in producing records frequently result in surveyors returning for a second or third day, extending inspections and increasing the potential for additional findings.

"The longer the surveyors are in the building, the greater potential for additional information or evidence to be gathered," Teske said. She reported that in nearly every survey she participated in since the start of the year, delays stemmed from facilities with electronic records that were not yet providing surveyors with direct login access, requiring staff to print copies instead.

Under the new guidance, facilities using electronic record systems are asked to provide surveyors with read-only login credentials within two hours of the entrance conference, along with clear instructions for navigating the system. Facilities are also encouraged to designate a staff member familiar with the software to assist surveyors as needed.

Surveyors will access records only within the scope of the survey and will follow established confidentiality protocols while on site. BAL noted that many vendors can assist facilities in setting up surveyor-specific access and encouraged providers not yet offering this option to connect with their electronic records vendor.

Shared Expectations Tool

Following similar efforts by the Department's Bureau of Nursing Home Resident Care (BNHRC), BAL is also developing a draft document, formally titled the DQA Provider Relationships During the Assisted Living Survey Process, that outlines mutual expectations for providers and surveyors throughout the inspection process. The document is already being referred to informally as the "shared expectations tool."

Vicki Whitman, regional director for the Northeastern Regional Office (NERO), presented highlights from the draft at the forum. The document addresses each stage of the survey, from the entrance conference through the exit conference, and includes provisions for conflict resolution.

Under the draft framework, surveyors are expected to conduct themselves professionally and respectfully, explain the survey process and anticipated timeline, make clear records requests, provide updates to the provider representative throughout the visit and conduct proper entrance and exit conferences.

Providers are expected to designate a representative to participate throughout the survey, supply records within two hours, maintain professionalism, encourage staff cooperation during interviews and observations and promptly share any documentation or context that may clarify potential findings.

If conflicts arise, the framework directs parties to attempt resolution on site. Unresolved concerns should be escalated to the BAL regional director. If the survey environment becomes physically or verbally unsafe, BAL will suspend survey tasks and determine when and how to resume.

Once finalized, the document will be posted to the BAL website and distributed during entrance conferences.

Provider and Surveyor Perspectives

The forum segment also featured testimony from an assisted living provider and two surveyors on what makes the survey process work well in practice.

Anne Altenhofen-Krause, a licensee with Alten Haus, a four-building assisted living organization in Fox Crossings with more than 20 years of operation, described the systems her organization uses to support efficient surveys. These include a current, well-organized survey binder maintained at each facility, off-site employee files accessible within 15 minutes and pre-configured read-only surveyor accounts within ECP, an electronic charting platform the organization has used for the past eight years.

"A survey is an opportunity to improve, to learn, and to strengthen our practices," Altenhofen-Krause said. She also emphasized the importance of staff preparation, noting that training on survey expectations begins at orientation and continues through ongoing in-services.

Surveyor Nicole Hall, who recently conducted surveys at all four Alten Haus facilities, confirmed that the practices described by Altenhofen-Krause directly reduce survey length and administrative burden. An organized survey binder, Hall said, can reduce what might otherwise be a lengthy records search to 10 minutes or less. Electronic records access, she added, can shorten the overall survey by hours or even days.

"By granting us direct system login access, we can review records independently, which drastically reduces requests to locate, print, or copy files," Hall said.

Survey Readiness Publication

Surveyor and nurse consultant Shelley Johnson previewed a forthcoming BAL publication titled Survey Readiness, designed to serve as a practical reference tool for community-based residential facilities (CBRFs), adult family homes (AFHs) and residential care apartment complexes (RCACs).

The publication will include guidance on developing a survey binder, required documentation for employee and resident files broken down by provider type, an overview of what to expect during entrance and exit conferences, survey preparedness best practices and a sample set of questions surveyors commonly ask staff. Johnson said the document can also serve as a staff training resource.

BAL anticipates releasing the publication this summer.

Providing Feedback

BAL is accepting feedback by email through Teske, Bureau Director Ken Brotheridge, regional directors or any BAL staff contact.