What is the Immediate Jeopardy declaration and how can senior living providers avoid it?

Immediate Jeopardy is the stuff of operational nightmares. Even the most well-run senior living providers can (and do) get blindsided by Immediate Jeopardy during the Conditions of Participation (CoP) survey process.

By Jindou Lee, CEO & founder, HappyCo

With government reimbursement revenue, resident satisfaction, reputation and much more riding on the subjective findings of a single surveyor, it’s no wonder that so many operators dread the day when folks from the Centers for Medicare & Medicaid Services (CMS) come knocking.

“Immediate Jeopardy used to be rare, but it’s becoming more common,” according to Susan G. Kratz, a lawyer with Nilan Johnson Lewis (NJL) in Minneapolis. In 2014, more than 10 percent of CMS-certified senior living providers were issued Immediate Jeopardy declarations.

But take heart! Despite inconsistent CMS surveyors, the exacting standards of CoP and the related Quality Indicator Surveys (QIS), you can identify beforehand which predictable, actionable practices will drive the outcome you want: a review free from deficiencies. With the right tools and a comprehensive ongoing strategy, you no longer need to fly blind when preparing for surveys.

What is CMS Immediate Jeopardy?

The CMS defines Immediate Jeopardy as “a situation in which the provider’s noncompliance with one or more conditions of [Medicare/Medicaid] participation has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident.” All Medicare- and Medicaid-certified senior living providers, including nursing homes, skilled nursing facilities (SNFs) and assisted living communities, must undergo compliance surveys and can find themselves in crisis if a CMS surveyor declares Immediate Jeopardy.

The CMS State Operations Manual (SOM) outlines three contributing factors that can result in Immediate Jeopardy: Harm, Immediacy, and Culpability.

Isn’t avoiding “serious injury, harm, or death” a primary reason many enter seniors housing in the first place? Well, here’s where things get vaguer and even more difficult to quantify. That’s because the SOM includes the following:

● Serious harm, injury, impairment, or death does not have to occur before considering Immediate Jeopardy.

● Psychological harm is considered to be as serious as physical harm.

● Individuals must not be subjected to abuse by anyone including, but not limited to, staff, consultants, volunteers, family members or visitors.

● Only one individual needs to be at risk. Identification of Immediate Jeopardy for one individual will prevent risk to other individuals in similar situations.

Of course you want to uphold the highest standards of care, but it’s difficult to know exactly how to comply when you’re navigating a sea of regulations. The possible triggers for Immediate Jeopardy vary from inadequate handwashing to inappropriate staff behavior and improper monitoring for drug titration.

However, the best strategic operational approach is to identify the most likely triggers for an Immediate Jeopardy declaration.

The CMS usually concentrates its efforts on inspecting current, specific government concerns. For example, in 2014, the Centers for Disease Control and Prevention (CDC) released new precautionary notes for glucometer testing to reduce the risk of exposing patients to blood-borne pathogens, so CMS surveyors closely reviewed healthcare organizations for compliance with these new guidelines. With this in mind, keeping a vigilant eye on policy developments can give you a leg up when you are preparing your facilities and staff for survey day.

Reducing Deficiencies Through Technology

Although there are no guaranteed ways to avoid all possible Immediate Jeopardy infractions, mobile platforms that empower regular periodic inspections that cover the same issues as the CMS CoP survey provide the exhaustive actionable, real-time data you need to take hold of the reins and manage your operations.

Operational excellence is your first line of defense for assuring quality care and preempting Immediate Jeopardy. When a patient, family member, visitor, physician or staff member expresses dissatisfaction with patient care or threatens to “file a complaint,” a visit from CMS could be forthcoming. The purpose of heeding these warning signs goes beyond preventing such complaints.

In other words, if you’ve been tracking and taking appropriate measures to address potential deficiencies all along, you substantially lessen your likelihood of being cited. Yes, CoP surveys are unannounced, but warning signs often abound — you just need to notice and act.

The thing is, “noticing” and “acting” aren’t as simple as they sound, especially if you rely on manual processes to maintain your CoP compliance.

Close monitoring is paramount to maintaining compliance. Executing inspections on a regular basis can afford the opportunity for senior living providers to gain comprehensive knowledge of their strengths, limitations and potential deviations from compliance, but only if the data your teams capture is aggregated and available in real time and organized in a way that is useful for management, so you can act quickly and decisively.

The key is establishing high standards of compliance across your facilities — yielding operational excellence founded in a data-driven approach that helps you apply fixes to both edge cases and more systemic problems, and critically, empowers you to know the difference.


Jindou Lee is CEO of HappyCo, a mobile platform for conducting inspections and monitoring workforce performance and onsite operations of residential properties and commercial facilities.