Do Israel's 'Pop Inspections' of Nursing Homes Surprise Anyone?

Some employees and former employees say they knew about 'surprise' visits by inspectors in advance.

Yaron Kaminsky

Although most of the Health Ministry’s inspections of nursing homes in 2016 were classified as “surprise inspections,” in many cases the institutions were informed ahead of time and prepared accordingly, Haaretz has learned.

Consequently, only 17 of Israel’s 305 nursing homes in Israel failed to meet the required standards in one or more of the inspected services. Only two old-age facilities failed to meet the required nursing standards, according to ministry figures. Of the 550 nursing-home inspections carried out last year, 60 percent were defined as surprise visits.

“One day I was told, ‘listen, tomorrow we’ll be a little more careful. The food will be a little warmer, because the Health Ministry is doing a pop inspection visit,’” said a woman who worked briefly at the nursing home on Kibbutz Afikim in 2011. Hagit Tzin, who worked as a cleaner and in the kitchen of the institution, says she quit after six weeks because she could not adapt to the work practices of the place.

“I asked, ‘if it’s a surprise visit, how do we know?’ And they said we have ways of knowing,” she said.

On the day of the inspection, “they suddenly feed [the residents] nicely and with respect, one attendant for two or three residents,” Tzin said. “Suddenly they play ball with the residents, suddenly nobody’s yelling at the old lady in the wheelchair who always needs help going to the toilet.”

For all of 2016, inspectors issued failing grades for environmental health, a category that includes sanitation and hygiene, on seven occasions. Six failing grades were issued in the area of occupational therapy, while two were issued for pharmacy, social work and nursing. One institution failed in the area of medicine, a different nursing home failed in nutrition. According to ministry figures, only seven nursing homes were fined in 2016.

“There’s no way a nursing home would get a score of 90 in a genuine surprise inspection,” said a woman who works at an old-age home in southern Israel. She asked that both she and her place of employment not be published.

The woman said that someone in the Health Ministry always gives the director of the place where she works a head’s-up about surprise visits. “The inspections are supposed to be a surprise, but there’s always a snitch in the ministry,” she said.

She said the moment they learn of a “surprise” visit, employees start preparing for it. “They have staff meetings, they scrub, clean, prepare relevant paperwork.”

Another former employee of the institution said she cannot recall a single inspection for which there was no advance warning.

Health Ministry figures indicate that in 2016, no nursing home in the Southern District received a failing grade.

An employee at a nursing home in northern Israel told Haaretz that most, but not all, of the supposed surprise inspections were not in fact a surprise. He said that in the 10 years that he has worked there, there has been one inspection a year, on average.

“Sometimes they come and inspect everything. In the surprise visits, they only checked the attendants’ schedule, what they do every minute,” he said.

“They overlook some things, or make a comment, but on the important things — hygiene and medicines — they do thoroughly,” he said.

An employee at a different northern Israel nursing home said that while there was never advance warning of surprise visits, they tended to be at around the same time every year. “We can guess. They’re not creative in this sense,” she said.

A number of employees and directors of nursing homes told Haaretz that the ministry had significantly increased the number of inspections in recent weeks, and that some facilities were inspected twice within a few weeks.

They said the ministry informs each nursing homes by email about its regular annual inspection, but not about the surprise visits.

“Surprise visits are held at all times, it can be at 5 A.M., 8 A.M., in the middle of the night like they did at my nursing home this week, it could be on Saturday night, or Friday, on the eve of a religious holiday, at any time. I think it’s great,” said Zvia Ben Zvi, the director of the Jerusalem assisted living facility home Beit Reuven. Ben Zvi said that she has never had advance knowledge of a surprise inspection, adding that says she herself conducts surprise visits of the facility.

Shimon Alenberg, the manager of the Beit Hanassi nursing home in Hadera, told Haaretz that it would be “very serious” if institutions had advance knowledge of surprise inspections, adding, “ I don’t know of such a thing and if it happens it’s improper. I can only condemn it.”

The Health Ministry has 43 nursing-home inspectors, working the equivalent of 28 full-time positions because some are part-timers. There are the equivalent of an additional 14.5 full-time inspectors in the geriatrics department. The Southern District has three inspectors who are employed in the equivalent of 1.75 full-time positions as well as three inspectors at Ashkelon’s Barzilai Medical Center, who work a combined two full-time jobs.

Of the 17 visits in the course of 2016 during which inspectors issued failing grades, 16 were surprise visits. That suggests that surprise visits are more effective than scheduled inspections. Seven homes were fined for lapses. In addition, the ministry reduced the price charged for a single day of hospitalization in 65 facilities and prohibited 108 nursing homes from admitting new residents.