South Carolina Nursing Home Blog : South Carolina Nursing Home Lawyer & Attorney : Poliakoff & Associates Law Firm : Elderly Care, Senior Care

New Jersey Newsroom had an article about nursing home operator Victor Napenas pleading guilty to Medicaid Fraud.  Napenas owned Valley Rest Nursing Home in New Jersey.  A state investigation discovered that he billed the Medicaid program for $302,877 in improper and unsubstantiated costs, including more than $100,000 in personal expenses.  The investigation began when state Department of Health and Senior Services (DHSS) surveyors noted severe deficiencies in the care delivered to residents.  The investigation discovered that the cost report included at least $302,877 in improper charges, including personal expenses and other amounts Napenas could not document or prove were spent for patient care.  Napenas issued business credit cards to himself and his wife through the nursing home, which they used for personal purchases, including trips to the Philippines, dance lessons and large family dinners. Napenas had those credit card charges and other personal expenses totaling more than $100,000 inserted into the cost report, resulting in reimbursement from Medicaid.

In pleading guilty, Napenas admitted that he fraudulently obtained payment from Medicaid for personal expenses unrelated to patient care. Prosecutors will recommend that Napenas be sentenced to only 90 days in a county jail as a condition of three years of probation. He must pay $302,877 in restitution to the Medicaid program, $45,263 in penalties, and $31,859 in provider taxes owed to the state. He will be prohibited from acting as a Medicaid provider for eight years.   Why should he ever be allowed to be a health care provider?

• Email This
• Print
• Comments
• Trackbacks
• Share Link

The Society of Actuaries is an educational, research and professional organization dedicated to serving the public, its members and its candidates. The SOA's mission is to advance actuarial knowledge and to enhance the ability of actuaries to provide expert advice and relevant solutions for financial, business and societal problems. The SOA's vision is for actuaries to be the leading professionals in the measurement and management of risk.

Findings from a new study released by the SOA estimate that measurable medical errors cost the U.S. economy $19.5 billion in 2008.  The study shows how 1.5 million medical errors compromise quality of American healthcare and cause unnecessary waste in the system

Commissioned by the Society of Actuaries (SOA) and completed by consultants with Milliman, Inc., the report used claims data to provide an actuarially sound measurement of costs for avoidable medical injuries. Of the approximately $80 billion in costs associated with medical injuries, around 25 percent were the result of avoidable medical errors.

Jim Toole, managing director of MBA Actuaries, Inc., said  "Of the $19.5 billion in total costs, approximately $17 billion was the result of providing inpatient, outpatient and prescription drug services to individuals who were affected by medical errors. While this cost is staggering, it also highlights the need to reduce errors and improve quality and efficiency in American healthcare."

Medical errors are a significant source of lost healthcare funds every year. For example, the study found that $1.1 billion was from lost productivity due to related short-term disability claims, and $1.4 billion was lost from increased death rates among individuals who experienced medical errors. According to a recent SOA survey, which identified ways to bend the national healthcare cost curve, 87 percent of actuaries believe that reducing medical errors is an effective way to control healthcare cost trends for the commercial population, and 88 percent believe this to be true for the Medicare population.

"We used a conservative methodology and still found 1.5 million measureable medical errors occurred in 2008," says Jonathan Shreve, FSA, MAAA, consulting actuary for Milliman and co-author of the report. "This number includes only the errors that we could identify through claims data, so the total economic impact of medical errors is in fact greater than what we have reported."

Key findings from the study include:

There were 6.3 million measureable medical injuries in the U.S. in 2008; of the 6.3 million injuries, the SOA and Milliman estimate that 1.5 million were associated with a medical error.
The average total cost per error was approximately $13,000.   In an inpatient setting, seven percent of admissions are estimated to result in some type of medical injury. The measurable medical errors resulted in more than 2,500 avoidable deaths and more than 10 million excess days missed from work due to short-term disability.

The study also identifies the 10 medical errors that are most costly to the U.S. economy each year. Approximately 55 percent of the total error costs were the result of five common errors:

Pressure ulcers
Postoperative infections
Mechanical complications of devices, implants, or grafts
Postlaminectomy syndrome
Hemorrhages complicating a procedure

The SOA and Milliman findings were based upon an analysis of an extensive claims database. Measureable costs of medical errors included increased medical costs, costs related to increased mortality rates, and costs related to lost productivity of an error.

• Email This
• Print
• Comments
• Trackbacks
• Share Link

There have been numerous news articles discussing how different states are proposing alternatives to nursing homes.  The number of Americans 65 and older is expected to more than double to 89 million by 2050.  The oldest of 79 million Baby Boomers turn 65 next year, a turning point that will begin to put pressure on social services, retirement homes and assisted-living facilities.  The percentage of people 65 and older is projected to climb from 13% today to 19% by 2050, while the share of adults age 20 to 64 is expected to drop from 60% to 55%, the Census Bureau says.  Everyone agrees that we must do something to keep its exploding elderly population out of nursing homes for as long as possible to curtail the crushing costs of extended institutional care.

USA Today's article referenced grass roots "Villages" sprouting up in neighborhoods across the country to help people age in their own homes.  More than 50 villages in a neighbor-helping-neighbor system have emerged. They are run by volunteers and funded by grants and membership fees to provide services from transportation and grocery delivery to home repairs and dog walking.

How villages operate:

•Residents pay a membership fee that varies from $25 to $600 or more a year, depending on the types of services members want. Some villages have paid staff members; others are run completely by volunteers.

•Most villages are opening in more upscale neighborhoods in cities and suburbs, but they all provide discount dues for lower-income elderly.

Capitol Hill Village, which began operating three years ago and is the oldest of six such villages in the nation's capital send folks to clean gardens, install railings, fix windows, bring groceries and run other errands.

Beacon Hill Village in Boston was the first in the movement, created by residents in 2001. It charges annual dues and delivers paid and volunteer help. The village movement is "consumer-driven and consumer-run," says Judith Willett, Beacon Hill's executive director. Beacon Hill partnered with NCB Capital Impact, a non-profit community development group, to launch the national Village-to-Village Network to help other areas. It is backed by funders such as the MetLife Foundation.

The Minnesota Star-Tribune had an article about Minnesota's Living at Home Network which includes 43 local programs and thousands of volunteers to assist the elderly in simple household tasks.  The Living at Home Network, once called the Block Nurse Program and the Elderberry Institute, dates to 1981.  Recently renamed, the loosely organized network just changed its budgeting and management to reaffirm its original mission, which allows localities to develop unique programs that all push the common goal of keeping the elderly out of nursing homes.

The network kept 1,222 elderly Minnesotans out of nursing homes in 2008-09.  Keeping people out of nursing homes also costs less. Caring for those same clients in nursing
homes would have cost an additional $20 million from taxpayers.  Multiply that by the thousands of other frail, elderly Minnesotans and the sums grow large.

Tax dollars spent on seniors' long-term care are projected to grow from roughly $1 billion in 2010 to $5 billion in 2035. In fiscal 2010, Minnesota spent $720 million on nursing home care for the elderly, compared with $333 million on non-institutional care. By 2035, the state hopes to reverse the ratio, spending $3.5 billion on non-institutional care and $1.5 billion on nursing homes.

Living at home is almost always cheaper and more comfortable than living in an institutional setting, said Kristen Whittenbaugh. She directs Nokomis Healthy Seniors, which serves 502 senior citizens on an annual budget of $165,000.

By comparison, in 2009 the average cost of a private room in a Minnesota nursing home was $54,750 a year, according to MetLife insurance company. In the Twin Cities, the annual average was $62,780.

• Email This
• Print
• Comments
• Trackbacks
• Share Link

The Center for Medicare Advocacy has been publishing a series of alerts regarding the Patient Protection and Affordability Care Act of 2010 and Health Care and Education Reconciliation Act of 2010. See link to their most recent one which focuses on the nursing home provisions of the bill.

Title IV, Subtitle B, of PPACA – Nursing Home Transparency and Improvement – addresses a variety of nursing home issues.

Part 1: Improving Transparency of Information

PPACA § 6101. Disclosure of Ownership and Additional Disclosable Parties. Effective immediately and upon request, skilled nursing facilities (SNFs) and nursing facilities (NFs) must make available to the Secretary of Health and Human Services (HHS), HHS Inspector General, the state, and the state long-term care ombudsman information about nursing home ownership (specifically, each member of the governing board, additional disclosable entities [which are defined as persons or entities that (1) exercise operational, financial, or managerial control over the facility or part of the facility or that provide policies and procedures or financial or cash management services; (2) lease or sublease real property to the facility; or (3) provide management or administrative services, management or clinical consulting services, or accounting of financial services to the facility]). Two years after enactment of the law (March 2012), the Secretary of HHS must publish final regulations. Ninety days after final regulations are published (June 2012), SNFs and NFs must report the information to the Secretary in a standardized format. One year after final regulations are published (March 2013), the Secretary must make the information available to the public.

PPACA § 6102. Accountability Requirements for Skilled Nursing Facilities and Nursing Facilities. Two years after enactment of the law (March 2012), HHS must publish final regulations for an effective compliance and ethics program, which may include a model compliance program. Three years after enactment of the law (March 2013), SNFs and NFs must have compliance and ethics programs in operation to prevent and detect criminal, civil, and administrative violations of the Act and to promote quality of care. Three years after final regulations are promulgated (March 2015), HHS must evaluate whether the compliance and ethics programs changed deficiency citations or made other changes to measures of quality, and must submit a report to Congress. HHS must also implement, by regulations, a Quality Assurance and Performance Improvement Program (QAPI) by December 31, 2011, which facilities must implement one year later.

PPACA § 6103. Nursing Home Compare Medicare Website. HHS must add to the official nursing home website, Nursing Home Compare, information about:

(1) Staffing data, including staffing turnover and tenure;

(2) Links to state internet sites, including links to the statements of deficiencies (reported on form #2567 and referred to as "2567s") and facility plans of correction;

(3) Standardized complaint form;

(4) Summary information on the number, type, severity, and outcome of substantiated complaints;

(5) Number of adjudicated instances of criminal violations by a facility or its employees that were committed in the facility, including those that involve abuse, neglect, exploitation, "or other violations or crimes that resulted in serious bodily injury."

The information must be presented "in a manner that is prominent, updated on a timely basis, easily accessible, readily understandable to consumers of long-term care services, and searchable."

HHS must establish a process to review the "accuracy, clarity of presentation, timeliness, and comprehensiveness" of information on Nursing Home Compare and make appropriate changes a year after enactment (March 2011).

To improve the timeliness of information on Nursing Home Compare, states must submit survey information to HHS no later than the date they send such information to facilities, and HHS must use the information to update the website "as expeditiously as practicable but not less frequently than quarterly."

The Special Focus Facility (SFF) program is mandated by statute. SFFs, defined as facilities that have "substantially failed to meet applicable requirements," must be surveyed at least every six months.

SNFs and NFs must have, and make available to anyone on request, reports about surveys and complaint investigations conducted within the prior three years. SNFs and NFs must post notice in a prominent and publicly accessible place that these reports are available.

HHS must provide guidance to states on establishing links to survey reports (2567s). States must maintain "a consumer-oriented website providing useful information to consumers," including 2567s, complaint investigation reports, and facility plans of correction.

HHS must develop a Consumer Rights Information Page on Nursing Home Compare that includes information and links on consumer rights and the survey process and state-specific information about services available through the state long-term care ombudsman.

PPACA § 6104. Reporting of Expenditures. Within one year after enactment (March 2011), HHS must redesign Medicare cost reports to require separate reporting of SNF expenditures for wages and benefits for direct care staff, including nurses and other medical and therapy staff. SNFs must begin using the new cost reports within two years of enactment (March 2012). Within 30 months of enactment (September 2013), HHS must categorize annual expenditures into four functional categories:

(1) Direct care staff;

(2) Indirect care (including housekeeping and dietary services);

(3) Capital assets; and

(4) Administrative services costs.

HHS must make the information available to interested parties on request.

PPACA § 6105. Standardized Complaint Form. Within one year after enactment (March 2011), HHS must develop a standardized complaint form that residents or persons acting on their behalf may use to file a complaint with a state survey agency or long-term care ombudsman program. States must establish a complaint resolution process that includes

(1) Procedures to assure accurate tracking of complaints,

(2) Procedures to determine the severity of complaints

(3) Procedures for complaint investigations, and

(4) Deadlines for responding to complaints.

In addition to the standardized form, complaints may still be submitted in other ways and formats, including orally.

PPACA § 6106. Ensuring Staffing Accountability. Within two years after enactment (March 2012), SNFs and NFs must submit, electronically to HHS, direct care staffing information (including agency and contract staff), "based on payroll and other verifiable and auditable data in a uniform format." Staffing information must:

(1) Specify the category of worker;

(2) Include information on resident census and case mix;

(3) Include a regular reporting schedule;

(4) Include information on employee turnover and tenure and hours of care per resident per day for each category of worker.

PPACA § 6107. GAO Study and Report on Five-Star Quality Rating System. Within two years of enactment (March 2012), the Government Accountability Office must submit a report to Congress on the Centers for Medicare & Medicaid Services's (CMS) Five-Star Quality Rating System, addressing how the system is being implemented, problems, and suggested improvements.

Part 2: Targeting Enforcement

PPACA § 6111. Civil money penalties. HHS may reduce a civil money penalty (CMP) by not more than 50% if a SNF or NF "self-reports and promptly corrects a deficiency for which a penalty was imposed." A reduction is not available for (1) a deficiency if HHS had reduced a CMP in the previous year with respect to a repeat deficiency and (2) a deficiency reflecting a pattern of harm or widespread harm, immediate jeopardy, or a resident's death. HHS must publish regulations providing for independent informal dispute resolution (IIDR). HHS may require placement of CMPs in an escrow account. SNFs or NFs that succeed on their appeals may receive the amounts collected plus interest.

CMP funds may be used for (1) activities "that benefit residents," including protecting residents whose facility closes or is decertified; (2) projects supporting resident and family councils and other consumer involvement in assuring quality care in facilities; and (3) facility improvement initiatives approved by HHS, including joint training of facility staff and surveyors, technical assistance, and appointment of temporary management firms.

Note: In an apparent drafting error, the law provides that per-day CMPs "may not be imposed" for any day during the period beginning on the initial day of the imposition of the penalty and ending on the day on which the [independent] informal dispute resolution process is completed. It is presumed that Congress meant that penalties would not be required to be placed in escrow accounts until completion of the IIDR process.

PPACA § 6112. National Independent Monitor Demonstration Project. Within one year of enactment (March 2011), HHS must begin a two-year demonstration project "to develop, test, and implement an independent monitor program to oversee interstate and large intrastate chains" of SNFs and NFs. HHS will choose chains from among those that apply for the project, focusing on chains with "serious safety and quality of care problems." The independent monitor analyzes the chain's compliance; conducts sustained oversight; analyzes management; reports his/her findings to the chain, HHS, and relevant states; and publishes the results. A chain must respond to the monitor's findings by submitting a report within 10 days, indicating corrective actions it will take or the reasons it will not implement the recommendations. A chain is responsible for "a portion of the costs associated" with the monitor. HHS must evaluate the demonstration in a report to Congress.

PPACA § 6113. Notification of Facility Closure. A SNF or NF administrator must provide written notice of a voluntary closure to HHS, state long-term care ombudsman, residents, and legal representatives 60 days in advance of the closure. Advance notice of a termination will be at the discretion of HHS. The administrator must ensure that no new residents are admitted after the date that written notice of closure is provided. The notice of closure must include (1) a plan (approved by the state) for the transfer and adequate relocation of all residents and (2) assurances that the residents will be transferred to the most appropriate facility or other setting in terms of quality, services, and location, taking into consideration the needs, choice, and best interests of each resident. HHS may continue payments until all residents are successfully relocated. An administrator who fails to comply with these requirements may be subject to a CMP of up to $100,000 and may be excluded from federal payment programs.

PPACA § 6114. National Demonstration Projects on Culture Change and Use of Information Technology in Nursing Homes. Within one year of enactment (March 2011), HHS will implement two three-year demonstration projects, one on "culture change" and the other on the use of information technology in nursing homes.

Part 3: Improving Staff Training

PPACA § 6121. Dementia and Abuse Training. Initial training for nurse aides must include "dementia management training and patient abuse prevention training." HHS may also require such training in aides' ongoing training.

ADDITIONAL PROVISIONS ADDRESSING NURSING HOME ISSUES

PPACA § 6201. Nationwide Program for National and State Background Checks on Direct Patient Access Employees of Long-Term Care Facilities and Providers. HHS must establish a nationwide program "to identify efficient, effective, and economical procedures" for background checks of workers with direct patient access, modeled on the pilot program conducted under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. The procedures must include search of state-based abuse and neglect registries, state and Federal criminal history records, and a fingerprint check. States must:

(1) Conduct the screening and criminal history background checks;

(2) Monitor compliance by long-term care facilities and providers;

(3) Provide for provisional employment, up to 60 days, for employees and for direct on-site supervision for employees pending completion of an appeal process;

(4) Provide for an independent appeal process for a provisional employee or employee to dispute the accuracy of information;

(5) Provide for a single state agency to be responsible for overseeing the process (including specifying the disqualifying offenses).

The federal match for a state program must be three times the state amount, not exceeding $3 million. The nationwide program applies to SNFs, NFs, home health agencies, hospice providers, adult day care providers, and residential care providers that arrange for or directly provide long-term care services, "including an assisted living facility that provides a level of care established by the Secretary." The Office of Inspector General must evaluate the nationwide program and submit a report to Congress.

PPACA § 6703. Grants and Training to the Ombudsman Program on Abuse and Neglect. This provision, part of the Elder Justice Act, provides grants and training to the ombudsman program on abuse and neglect. It also establishes a National Training Institute for Federal and State Surveyors to improve surveyor training in abuse and neglect, provides for grants to improve state survey agencies' complaint investigation systems, and requires a study on establishing a national nurse aide registry.

PPACA § 10325. Revision to Skilled Nursing Facility Prospective Payment System. Revisions to the Medicare prospective payment system (PPS) for SNFs are delayed from October 1, 2010 to October 1, 2011, except for changes to concurrent therapy and the look-back period, which were published in the final PPS regulations on August 11, 2009 (74 Fed. Reg. 40288). The Minimum Data Set 3.0 will become effective October 1, 2010.
 

• Email This
• Print
• Comments
• Trackbacks
• Share Link

The St. Louis American had an article about the prevalence of "hospital dumping" in St. Louis.  The article says that four times a week a nursing home resident calls in a panic because they were sent to the hospital for a medical or mental health condition. Then, when the hospital discharges the patients, the nursing homes won’t take them back.  This, of course, is against the law.  But the nursing homes don't care because the law is not enforced.

By law, skilled nursing facilities are required to give their residents a 30-day notice if they want them to leave the facility. 

If there is a reason why its staff can’t meet a resident’s medical needs, the facility should call the Missouri Department of Health and Senior Services.  However, the need is immediate and bureaucrats are busy.  Cheryl Wilson, director of the ombudsman services for the St. Louis Long-term Care Ombudsman Office, said the issue keeps her team running around in frantic circles all week, leaving them hardly any time to attend to other advocacy duties.

At Christian Hospital, in North St. Louis County, it happens “too many times not to be addressed by the State,” said Diana Tucker, social work case manager.

The State can’t quantify the number of cases because citations are not searchable by the type of violation.  The facilities say they would rather be cited by the State than take the resident back, Wilson said.

Both the ombudsman program and nursing homes are burdened with the surge in mental health patients. The State’s mental health care budget is dwindling every year. With psychiatric facilities closing, the patients are now moving into the nursing homes, Cheryl Wilson said.

This year, legislators severely slashed funds for the State’s two remaining psychiatric emergency rooms, as well as long-term care for people with mental illness and home care for the elderly.

• Email This
• Print
• Comments
• Trackbacks
• Share Link

Joanna Weiss of the Boston Globe wrote a great article on Medicare and waste. Below is excerpts of the article which is based on her experience with a relative on Medicare.  One axiom of our Medicare system: It’s hard to understand how maddening it is until something happens to your family.

Take, for example, my own elderly relative, who recently spent time in the hospital. Everyone wanted him to recover at home, but we knew that would require nursing care. And his care coordinator in the hospital had strange, bad news: If he went to a residential nursing home, Medicare would foot the bill. But if he wanted an at-home nurse, at substantially less cost, Medicare would only cover a few hours of care, a few days a week.

To anyone with a smidge of common sense, that sounds absurd. But when I relayed the story to Dr. Brent James, he wasn’t surprised. As chief quality officer at Intermountain Healthcare, a network of hospitals and providers in Utah, he’s an expert in Medicare’s one-size-fits-all solutions and perverse incentives. More than a decade ago, his hospitals put a reform in place, involving the timing of antibiotics, that helped patients recover more quickly and completely. But the hospitals were losing millions of dollars, and the billing records solved the mystery. If a patient got pneumonia and went on a ventilator, the reimbursement from Medicare was $800 more than the treatment itself. If that same patient didn’t get pneumonia, the billing codes changed, and the payment for his briefer, simpler hospital stay was $800 less than the cost.

James has implemented many solutions at Intermountain. Among them are “global payments,’’ which opponents have managed to demonize as rationing of care. As James explained it to me, it’s a far-less-nefarious way to create the the right incentives in a system that now often has the wrong ones.

In the case of my elderly relative, Medicare would give his hospital a set amount of money to coordinate and spend. Any money left over would be profit. If the payment fell short of the cost of his care, the hospital would eat the loss.

In theory, that could give doctors and nurses a reason to provide him with less care. Careful monitoring of quality would have to go hand in hand with global payments. But this change could also encourage steps known to reduce the length and cost of illnesses. Washing hands more often to reduce the spread of infection. Coordinating better among hospital divisions. Offering better access to the home-based nursing care that would cost a lot less.

“Over 50 percent of expenditures on a patient on health care are technically waste,’’ James told me. But “one person’s waste is another person’s income is a major political contribution.’’

According to some health care and economics experts — including Roger Feldman and Bryan Dowd at the University of Minnesota and Bob Coulam at Simmons College, who wrote a recent paper on the subject — competitive pricing would shave 8 percent off the annual Medicare budget. That amounts to $50 billion to $60 billion every year. And yet, every time that reform has been proposed, providers have revolted, and Congress has blocked it in a very bipartisan way.

Now we have a looming crisis, a foreseeable future when the Medicare Part A trust fund will go bankrupt, or when Medicare costs will start to overwhelm the federal budget. There will come a point when ignoring the problem won’t be feasible anymore. Maybe it will happen too late to help some of my own relatives. But when it does happen, there’s some small comfort in knowing that solutions are out there — just waiting for action, a little bit of courage, and a will to change.
 

• Email This
• Print
• Comments
• Trackbacks
• Share Link

Ashley M Jones wrote on the Pharmacy Technician Certification blog the following article on the 12 most common medical errors and how to prevent them.  Many of these errors occur in nursing homes every day.

According to the National Academy of Sciences, medical errors injure millions of people each year and cost billions of dollars annually in increased health costs. And this does not take into account lost wages or productivity costs. If that isn’t frightening enough, the Institute for Healthcare Improvement estimates that more than 238,000 hospital deaths among Medicare patients between 2004 and 2006 were due to medical errors that could have been prevented.

With healthcare reform front and center in political discussions, but little coming from it, patients are left to rely on their overworked physicians and other caregivers for reliable services. To best avoid becoming part of the statistics, become part of the solutions by knowing the 12 most common medical errors and how to prevent them.

1. Medication Errors : The most common of medical errors, luckily it can be one of the most preventable. Errors include assigning a medication due to improper information such as allergies, other medications taken, previous diagnosis, and others. A medication error can also include lack of up to date warning or miscommunication due to poor handwriting. There is also confusion among drugs with similar names or dosage, and this effects all drugs including prescription, over the counter, vaccines, etc. The best way to avoid this medical error is to know what you’re taking, how much, and what you can’t take. If unable to remember, bring all of your medications to the doctor or hospital with you.

2. Bad Communication :  Have you been going to the same doctor for years? That doesn’t mean that he or she knows or will remember everything about you. The second most common medical error results from poor doctor/patient communication. With loads of tests and labs, doctors will not always remember every test you have, so it is up to you. The Agency for Healthcare Research and Quality lists the ten questions every patient should ask their doctor, along with many other useful tips. You can even go there to build your own personalized question list.

3. Infection : They may seem clean, but hospitals are one of the most likely places to receive an infection. Given the high incidence of people with infections, workers who can become contaminated, and the fact that many patients enter the hospital with weakened immune systems, infection can be a serious problem. If staying at a hospital, be sure to avoid a doctor’s tie, ask him or her if they have washed their hands since visiting the last patient, and be sure to wash your own often. This article reports on the incidence of high IV infection rates. If you receive one, be sure to monitor for signs of infection and ask for a new one if suspicious.

4. Falls : Because on so many new drugs, patients cannot predict how they will react to them, causing a fall, which is another leading common medical error. In fact, ten percent of falls for the elderly occur in hospitals. Patients who have other mobility issues like a broken leg, walker, or cane, can also find the clean hospital floors more slippery than those at home. If you think you need assistance standing and walking, contact the nursing staff. Be sure and allow 10-20 minutes for a response, as they may be busy assisting others stand and walk.

5. Surgical Errors : Because surgery is scary enough when everything goes right, it is vital to prevent errors before, during, and after. These can include wrong site, wrong procedure, and even wrong patient surgeries. Although there are new procedures in place to reduce these common medical errors, you can still do your part. Speak to your surgeon about the procedure you are having, why you are having it, and what the surgeon will be doing during the surgery. Also know the rules in place to avoid surgical errors: 1. The surgeon must sign the incision site with the patient awake. 2. Use only a signature and not a confusing “X.” 3. The entire surgery team must stop and perform a checklist before beginning the procedure.

6. Pharmacy Errors : You don’t have to be in a hospital to be a victim of a common medical errors. With dozens of patients each day, pharmacies can also make errors on your medication. In fact, according to this article from CNN, 30 million Americans are the victim of outpatient medication errors each year. Although some are minor and can be caught easily by most patients, others are not. To best prevent medical errors of this sort, know what your doctor prescribed and how much when going to the pharmacy. Also, be sure to be honest with the pharmacist about other medications and drugs you are taking to ensure that there is no harmful interaction.

7. Lab Errors : Another facility with many patients and tests in one spot, common medical errors can occur here as well. These can also be truly devastating by leading to wrong diagnosis and wrong treatment, while the initial disease continues. Types of common errors can include MRI or CT taken incorrectly, samples taken incorrectly, or results misinterpreted. If you feel your lab results are misleading, you are within your rights to ask for another lab test to confirm.

8. Treatment Errors : If you feel your diagnosis was reached correctly, a common medical error can still happen during treatment. Because many doctors have been practicing for decades, it is not unusual for them to be using outdated procedures. Be sure to ask why you are having the treatment, how long the doctor has been doing them, and if there are any alternatives. This website is full of guidelines for treating many common illnesses.

9. Follow Up Care : When discharged from the hospital or clinic, be sure and know what your follow up care is and what to expect from it. If you are given a specific amount of medication and told to take it all, take it all. Just because you feel better halfway through, doesn’t mean you are better. Ask the facility who to contact if you have follow up questions on your at home care. This link also has more on what to do.

10. Birth Injuries : It may be the most joyous time in your life, but birthing a child can also lead to medical errors. The most common can result in serious injuries such as cerebral palsy and paralysis. Women who are most at risk include those with large babies, prematurity, prolonged labor, and more. To best avoid these injuries, do research on the place you would like to have your baby in. Check several hospitals in and outside of your area. See the incidence of birth injury and, if possible, read reviews by other mothers who gave birth there.

11. Bring Family : This is vital to avoiding common medical errors. If you are too ill to answer or too tired to protest, an informed family member is your best bet to sidestepping a common medical error. They can answer questions about medications, do reviews of your current and future care, and lift spirits. Make sure they also read these 12 most common medical errors and how to prevent them. Click on this link to get more rules for family members visiting at a hospital.

12. Don’t Wait Until It’s Too Late : With healthcare costs on the rise, many patients believe they can save money by putting off the doctor’s visit. However, this can actually have the opposite effect as the worse a disease gets, the harder and more expensive it is to treat. This decision can also be deadly with the wrong disease going undiagnosed or treated. If you have no insurance, find a Take Care Clinic. Visits start at $65, which is far cheaper than many primary care visits out of pocket. They are also doing free blood glucose testing for the month of February.

If you have any questions regarding the above 12 most common medical errors and how to prevent them, ask your physician. The best way to not become lost in a system like so many million before you is to be your own best advocate. Know your rights both as a patient and an insurance holder. If you don’t have insurance, there are still many resources for you, along with many useful tips for those who do have it.
 

• Email This
• Print
• Comments
• Trackbacks
• Share Link

Argus Leader had an interesting article written by Anna Bahney about a new invention that may help wheel chair bound residents.   Greg Johnson designed the wheel-chair to help his parents. Glenice Johnson spends her day in a wheelchair that her son developed, and Greg has turned over the wheelchair to a group of South Dakotans who work to find others who could benefit the way his mom has.

The chair, called the Dignity200, is the first wheelchair on the market that allows what the makers call "self-toileting."  The user pushes a lever that drops a center panel from the seat. The person backs the chair over the commode, readjusts clothing and urinates or allows for a bowel movement as if sitting on a toilet seat. Once clean, and after adjusting clothing, the user moves the chair away from the commode and the panel is returned to place.

"If I'm here by myself, I can take care of what I need to," Glenice said. "Mentally and emotionally, it is a tremendous plus. It makes all the difference in me being at home."

The adjustable, custom-built chair, available at Kreisers medical supply store in Sioux Falls and a growing number of similar stores, costs $2,950.   It is an expensive chair, Greg admits. But chair effectively pays for itself every three weeks, considering that a month's stay in a long-term care facility can run at least $5,000.

But the greatest benefit might be a wheelchair-bound person staying home as long as possible.

Greg said he was able to figure out how to remove the understructure from beneath the wheelchair but couldn't work out the drop-down panel.  He called up a rancher friend with a background in engineering to pick his brain.   Together, they began to work on prototypes. The hardest part, Greg said, was "making sure the seat cushion would be of a quality that allows her to stay in the seat all day. If that didn't work, it wouldn't be possible."

The Dignity200 now is approved by the Federal Drug Administration and is in testing for applications outside the home. According to the Centers for Disease Control and Prevention, health care workers who routinely lift and move patients have a higher risk of injuries than workers in most other occupations, and the number of those injuries are increasing.

In September, the chair became part of a risk prevention study overseen by the University of South Dakota medical school in partnership with the Good Samaritan Society.

"The lifting and transferring from chair to commode and so forth for residents whose conditions tend to be frail, that's a significant issue and a significant source of injury to residents and staff," said Bill Kubat, vice president for resident community and quality service at the Good Samaritan Society.

A trial of the chairs at a Good Samaritan facility helped the chair get where it is now. Stories emerged, including staff who felt the chair made their work safer and a woman who had not used the bathroom on her own for four years and cried when the chair had to be returned at the end of the trial.

But the longest test case has been Greg's mom, who has been in the chair for two years.

"For my mom, she can feel like she's on her own a little more again," Greg said. "And my dad doesn't have to be home. He's got a lot more freedom and he's doing a lot less lifting. It has changed their life."

• Email This
• Print
• Comments
• Trackbacks
• Share Link

TriCities.com had an article about the case of Anne Brightwell.  She died in a hospice bed June 16 after months of screaming over a fractured left femur that would not heal.  Her upper leg bone shattered Feb. 6, when a hammock sling, used by Cambridge House nursing home staff to hoist her from a bed to a wheelchair, snapped. A medical examiner listed the broken femur as the cause of death on Brightwell’s death certificate.

The fall could have been prevented.  The nursing home had a history of using aging and tattered slings, but throwing newer equipment into use only when Tennessee Health Department inspectors arrived.  Three former Cambridge House employees say administrators hid daily-use equipment from inspectors, only to later pull it out after tucking away the newer items until the next state visit.

Cambridge House is part of a national chain of for profit nursing homes owned by AltaCare Corp., based in Alpharetta, Ga.  A letter faxed to the newspaper by Cambridge House confirmed “an incident involving use of clinical equipment, resulting in an injury that was treated in accordance with accepted clinical standards of practice.”
 
“Granddaughter Amy Shell noted in an interview that Brightwell lived through her twilight years without ever needing prescriptions for such common elderly ailments as high blood pressure or cholesterol.  Brightwell landed in a Cambridge House bed to rehabilitate an ankle she fractured at her Bristol, Tenn., home, where she lived alone, except for nightly visits from relatives.  Shell said Brightwell likely would have left the nursing home after rehab was complete.

Expectations changed the day the hammock sling snapped, with Brightwell awkwardly slamming to the floor on her left side.  Because of her age, the bone would not heal on its own. And, at her age, surgery to amputate the leg might have killed her.  The only option left for the aging matriarch was to rely on pain pills. Family members said it didn’t offer much help.  “Mom would lay in bed and say ‘Help me please, help me God, Jesus,’ and this would go on for hours,” Countiss said.

Former nursing aide Dickie Norris recalled in an interview the threadbare condition of the three hammock swings used at Cambridge House from last year until soon after Brightwell’s fall.
“They were frail ... like a worn out pair of jeans,” said Norris, who joined the nursing home in June 2008 and left in March.  The lifts remained in use until four weeks after Brightwell’s fall. Norris said he was lifting a patient out of bed and had him in midair when an administrator appeared and told him to get the patient down and hand over the sling.  “Then they ordered slings, but they wouldn’t work on the (pulley) machines,” Norris said. “We couldn’t get people up for physical therapy for weeks.”

Former nursing aide Brian Gross, who worked at the nursing home from May 2008 until October 2008, did not trust the slings.  “In those slings, I wouldn’t want to be lifted in it, and I weigh only 140 pounds,” he said.   Gross estimated that many of the nursing home’s patients weigh more than 200 pounds.  Gross recalled that the slings shown at inspection were slightly used, but in much better shape than the ones kept in daily circulation.

The hammock slings might have been discarded months earlier, had state inspectors seen them. Past nursing home employees said the Cambridge House administration went so far as to hide shabby equipment during health department inspections.  Former nursing aide Tony Apple, in a sworn deposition provided by lawyer Parke Morris, said that administrators pulled out newer equipment specifically for annual state inspections.  “Once the state inspection was over, the old slings came out,” Apple said in the deposition. 

Not only were the hammock slings in ill shape, said Shawna Caudill, a former Cambridge House nursing manager, but the bedsheets, towels and other linens showed considerable wear, too.
Caudill, who joined Cambridge House in April 2007 and left in November 2008, said the administration purposely overlooked the shabby quality of equipment.  “The faulty equipment was definitely brought up at many meetings, but it all boiled down to cost,” Caudill said.   One administrator’s “exact words were to put on my big-girl panties and deal with it.”

• Email This
• Print
• Comments
• Trackbacks
• Share Link

McKnight's had an article about salary increases in Administrator and Director of Nursing positions.  CNA pay appears to be static.  Nursing home management salaries rose at a healthy rate this year, despite the recessionary environment, according to the recently released “2009-2010 Nursing Home Salary & Benefits Report” from Hospital & Healthcare Compensation Service. The publication is created in association with the American Association of Homes and Services for the Aging, and the American Health Care Association, the nation's largest nursing home associations.  National median salaries for both nursing home administrators and assistant administrators rose by 4.8% in 2009, according to the HCS survey. Administrators' salaries climbed to $89,606, up from from $85,464 last year.   Nurse management who typically do not provide direct care enjoyed an overall pay bump. Directors of Nursing matched last year's pay increase of 3.9%, putting the national median at $77,921. The assistant DON median rose by a bigger margin–4%–putting it at $62,400 per annum.

The article points out that the economic stability of the long term care industry is doing well despite the cuts in Mediciad and the economic recession.    Although resident numbers are down and, particularly in the not-for-profit sector, fund-raising efforts are down as well. Still, administrators at not-for-profit facilities averaged an almost 7% pay rise over last year. (The 4.8% average is for administrators from the both for-profit and not-for-profit sectors.)

The unsustainable trajectory of current healthcare spending is one of the big reasons healthcare reform is necessary, although it remains to be seen what will happen under a new plan.   The Employee Free Choice Act contains three major provisions that would help make it easier for unions to organize: a card-check provision, allowing a union to form if a majority of workers (50% plus one) sign a card in support of organizing; a mandatory arbitration clause that would impose a working contract on both the new union and management if those parties cannot agree with each other within 90 days; and a provision that would alter the rules governing union elections, reducing the amount of influence management can exert on union voters.   Conventional wisdom says that if EFCA passes, organizing in healthcare will go up, and with it, employee wages.  

The healthcare discussion has perked up the ears of many long-term care accountants and various executives, who are struggling to prepare for possible Medicare reimbursement cuts and market basket eliminations. When you consider that even small changes in a facility's payroll, especially in larger metropolitan facilities that employ thousands of workers, can add up to millions of dollars.

• Email This
• Print
• Comments
• Trackbacks
• Share Link