This was a CARF year at Morningside. At the survey’s end we once again received a three year accreditation – the highest possible. I figure this is Morningside’s 15th CARF survey process and my 9th survey as CEO. So what is CARF?
CARF was established in the late 1960s to provide independent accreditation for rehabilitation facilities providing services ranging from aging to medical rehabilitation. The basis of each survey is a highly detailed, even intricate, set of standards. Annually a confab of practitioners works on establishing standards in their specialty areas. The standards are scrutinized by professionals working in the field before being ratified by the CARF board. The survey is actually conducted at each location by volunteers who are touted to be subject matter experts. The CARF website states that “The CARF International group of companies currently accredits more than 50,000 programs and services at 23,000 locations. More than 8 million persons of all ages are served annually by 6,800 CARF-accredited service providers.”
The web site further states ‘In 1970 The Council of State Administrators of Vocational Rehabilitation passed a resolution urging state agencies to work toward the goal of requiring all organizations providing rehabilitation services to be accredited by CARF. This was one of the key developments in the history of the Commission.’ Washington State has required rehab agencies to be accredited since the 1980s and picked CARF as the sole accreditation body in 2003.
I like the idea of accreditation. I like the standards. I even agree with most of them. But the question is: Does accreditation lead to better services? I am not so sure. In fact, I can make the case that it does not. My real problem is that the State of Washington has made CARF accreditation mandatory to provide services in the state. It sounds like such a good idea – all agencies must meet certain standards and be granted accreditation to provide services. But as with so many things, it’s not the idea but the implementation or maybe the law of unintended consequences. Regardless of the reasons, once a seal of excellence, I now know some pretty shoddy programs in this state that have received CARF accreditation since it became mandatory. In my opinion this reflects on all programs and diminishes the meaning of the accreditation. The gold seal of approval is a bit tarnished and has gone from denoting elite status to the box-checked-off category.
I also continue to be concerned that the quality of surveyors is slipping as well. The three who were assigned to our 2015 survey were, well, terrible. While the surveyor responsible for reviewing our administrative functions was adequate at best, the two program surveyors were basically incompetent. And these individuals are currently working in the rehabilitation field! It’s certainly possible that so many surveys are required there simply are not enough qualified surveyors to go around. I have so many amazing stories of surveyor ineptitude they are now legion. Suffice to say I strongly encouraged CARF to seriously review whether surveyors are actually able to perform this job. I appreciate that CARF provides an opportunity to comment on the survey but, after this year, they may be sorry they asked!
What can be done to improve this situation? Since we need better surveyors we can seek out and encourage qualified individuals to volunteer. To that end I encouraged one of our many excellent staff to become a surveyor. Even though asked several times I never volunteered. Initially because being away from a young family proved uninviting but now, at this critical point, CARF needs surveyors that are smart, energetic, and part of forward-leaning programs to raise the bar once again.
Additionally, maybe if the state paid directly for the survey there might be more interest in the quality of survey. I don’t think agencies understand or care about CARF – it’s just a seal on the wall or a box to check for their review. Since the state says it is a cost of doing business – one they impose – from my perspective I want to pay the least amount possible! So the battle cry might be “Give me Quality or Give me Cheap”!
CEO Viewpoint is published by Jim Larson, CEO Morningside
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