Issue Paper

A Federal Waiver to Pilot an Alternative Nursing Home Survey Process in Wisconsin


It appears very few of those in Wisconsin who care about the nursing home survey process are satisfied with the current system. Providers see staff morale at an all-time low, with those who remain in caregiving feeling totally unappreciated and all too many compassionate caregivers leaving the field altogether. Advocates believe the level of quality care in nursing homes has not risen to the levels they had anticipated would result from the OBRA 1987 nursing home reforms. Regulators are caught in the mutually-exclusive role of enforcer and consultant.

This consensus of dissatisfaction has led to preliminary discussions on developing an alternative nursing home survey system. Those discussions have included the provider associations, the State Ombudsman, and representatives from the Bureau of Quality Assurance. Department of Health and Family Services Secretary Joe Leean recently told WAHSA members he, too, supports these efforts.

What such a system would look like would be a product of collaboration and compromise. Certainly, it would be outcome-based. Most likely, it would provide incentives and rewards for good providers and focus more intense regulatory activity on poor performers. Hopefully, it will enable surveyors to share their expertise rather than focus solely on policing providers. Regardless, the final product will have to be one equally embraced by providers, advocates, regulators, and most importantly, residents and family members. Without a consensus approach, this effort is doomed to failure.


As soon as an alternative survey model is developed and accepted by its stakeholders, we would ask our Congressional delegation to take whatever statutory or regulatory actions are needed to enable Wisconsin to pilot this alternative nursing home survey process.

The Wisconsin Association of Homes and Services for the Aging (WAHSA) is a statewide membership organization of not-for-profit corporations principally serving elderly and disabled persons. Membership is comprised of 190 religious, fraternal, private and governmental organizations which own, operate and/or sponsor 194 not-for-profit nursing homes, 71 community-based residential facilities, 39 residential care apartment complexes, 100 independent living facilities, and 446 community service programs which provide services ranging from Alzheimer's support, child day care, hospice and home care to Meals on Wheels. For more information, please contact the WAHSA staff at (608) 255-7060: John Sauer, Executive Director; Tom Ramsey, Director of Government Relations; or Brian Schoeneck, Financial Services Director.

WAHSA 204 South Hamilton Street Madison, WI 53703
Telephone: (608)255-7060 FAX:(608)255-7064