Nursing Home Treatment is Found to Often be Harmful
[Editor's note: the following blog post was written by Brian Garavagli]
A national report on nursing homes, conducted by the Office of the Inspector General of the United States Department of Health and Human Services, has found some very sobering, if not frightening, results. The study found that as many as one-third of all nursing home residents were harmed by their treatment!
The Office of the Inspector General used a large sampling of Medicare patients that were discharged from hospitals to nursing homes within a particular year. It found approximately one-third of the patients that were studied in these nursing homes experienced treatment that harmed them in some way. It was also found that most of these cases of harm were preventable.
Ruth Ann Dorill of the Department of Health and Human Services stated, "We were surprised at the seriousness of many cases." Many of the problems were not based on case or treatment complexity. Dorrill states that many of the issues were oversights and failures in carrying out proper everyday care. In other words, many of the cases of harm that existed were due to failures in carrying out normal standard protocol correctly. Paying proper attention or failing to monitor an individual correctly were often some of the apparently simple, yet highly important oversights, which lead to many harmful forms of nursing home care, or maybe better stated, lack thereof. Dorrill states that many of these forms of improper treatment intervention leading to harm fall under the classification of "what clinicians would call substandard medical care."
The study found that approximately 60 percent of the nursing home residents that experienced harmful treatment eventually ended up being readmitted back into the hospital. The Office of the Inspector General estimates that the cost to Medicare for such improper and substandard care is approximately 2.8 billion dollars annually. This 2.8 billion dollar estimate is just considering the hospital cost, and it does not entail the cost of physician care and extra time spent being readmitted to a nursing home. Therefore, the cost of improper medical treatment in nursing home care may be adding considerably to the overall health care expenditures that exist in our country. This, during a period in which the government and many third party paying sources are strongly attempting to curtail health care costs, which has become a serious economic problem for our country. However, given the serious economic impact that it has on our health care system, more serious are the concerns related to the potential harm, and in some cases death, that has resulted from improper care.
Dorill states that today's nursing homes are harboring sicker individuals than in the past, and many have a greater complexity of care found within their nursing home populations. Given this, they need to have staff that pays particular attention to the regimentation of treatment protocol, covering a greater number of patients than had previously needed such types of oversight in past decades. As the population ages, this will become an ever-increasing problem as more individuals may be in need, at least for short-periods of time, of care and rehabilitation provided within a nursing home setting. That being the case, what is quite disconcerting is that many of these forms of inappropriate treatment that lead to harm, or even to the death of the patient, were often simple human factor issues. Paying attention to the administration of certain medications, providing proper attention to prevent falls, or providing proper food administration to prevent aspiration are some of the issues that were found to exist. Many of the problems therefore were not due to a technical inability found to exist in the provider of care. They were acts of omission or commission that could be considered very preventable forms of negligence.
What can be drawn from this current study? First, there are still considerable care issues that need to be addressed in the nursing home industry. There have been considerable improvements over the past couple of decades, especially since nursing home care improvement was targeted by the federal government and the Institute of Medicine in the 1980's. However, to paraphrase Robert Frost, the nursing home industry still has miles to go until we can sleep. Furthermore, a more effective and efficient form of care has to be focused on, especially toward eliminating unnecessary behaviors and interventions that can actually not only harm individuals, but exacerbate their conditions that lead to greater health care costs in the long run. As was found, many of the clinical aspects that may need to be targeted to avoid harmful treatment interventions are not highly complex issues, in as much as they are human factor issues. Subsequently, better logistical processes, focusing on human factor engineering issues may be of considerable importance. One last thing to note as well is that iatrogenic forms of illness or treatment are not unique to the nursing home area. Nevertheless, the study's finding of approximately a third of all Medicare nursing home residents experiencing some form of harm has to give one great pause, as well as sensitize the nursing home industry toward addressing this deficiency properly and expediently.
Jaffe, I. (2014, March 5). One-third of nursing home patients harmed by their treatment. Accessed at: http://www.npr.org/blogs/health/2014/03/05/286261742/a-third-of-nursing-home-patients-harmed-by-their-treatment