Stop Paying Nursing Homes That Injure Elderly and Disabled People

Steve Gold's Information Bulletin #264 (10/08) On October 1, 2008 Medicare announced that it would stop paying hospitals for injuring patients. The Centers for Medicare and Medicaid Services listed 10 "reasonably preventable" conditions for which it would no longer pay hospitals. These "preventable" conditions included injuries from patients who fell in the hospital, catheter-associated infections, stage 3 and 4 pressure ulcers (aka bed sores). Why has CMS not addressed "reasonably preventable" conditions and injuries that nursing homes cause elderly and disabled persons? Why has CMS not instructed States to stop Medicaid payments to those nursing homes that cause specific injuries? Why is this standard applied only to hospitals? In mid September, 2008, the CMS Inspector General issued a report which stated "in each of the past 3 years 2005-2007, over 91 percent of all nursing homes surveyed were cited for deficiencies ... and 17 percent of the nursing homes (in 2007) ... were cited for actual harm or immediate jeopardy deficiencies...." The federal regulations define "the most serious level, immediate jeopardy, occurs in a situation in which the provider's [i.e., the nursing facility] noncompliance with one or more of the requirements of participation has caused, or is likely to cause,serious injury, harm, impairment or death to a resident'. "Hmm. "Noncompliance"in nursing facilities that cause injuries ="reasonably preventable" injuries in hospitals? The punishment: hospitals lose Medicare funds, nursing facilities barely and rarely get their fingers slapped and continue to receive Medicaid fund. What makes the nursing facility noncompliance even more egregious is that hospitals cause individual patient injuries but nursing facility's noncompliance is by definition "widespread" or a "pattern" b thus causing actual harm and immediate jeopardy to many residents. Okay, so the recent CMS Inspector General report focused only on2005-2007. Let's look at the CMS Inspector General's earlier report for 1998 - 2001."In 2001, 89 percent of all nursing homes surveyed were cited for at least one deficiency, an increase from 81 percent in 1998." In 2007, it rose to91 percent!. What about the "immediate jeopardy" and "actual harm" deficiencies? From1998 - 2001, the percentages rose from1.4% to2.3% of those nursing facilities surveyed. In 2007, it rose to 17%!. Even if CMS does not have the courage to penalize nursing facilities for these deficiencies, surely our tax money should not compensate them for"reasonably preventable" injuries and conditions. Here are some injuries and conditions in nursing homes, as reported by the2007 CMS OSCAR data, that are "reasonably preventable" and therefore CMS should apply the same penalty to nursing homes as it applies to hospitals: 19.1% of nursing facilities had residents with avoidable pressure sores,and the nursing facilities received deficiencies for failing to meet the federal standard. Up from 17.2% in 2001. 11.8% of nursing facilities imposed physical restraints on residents for purposes of discipline or convenience and not required by the residents' medical symptoms, and they received deficiencies for this category. Up from 11.0% in 2001. 19.2% of nursing facilities had failed to prevent incontinence in residents and to restore bladder functioning as much as possible to residents, and the nursing facilities received deficiencies. Up from 12.0%in 2001. 7.0% of nursing facilities failed to provide residents with acceptable nutrition to maintain their body weight, and the nursing facilities received deficiencies. Down from 8.4% in 2001. 37.9% of nursing facilities failed to ensure residents with environments"free of accident hazards" to "prevent unexpected and unintended injury,"and the facilities received deficiency citations. Up from 22.1% in 2001. 6.6% of nursing facilities failed to provide residents with appropriate range of motion services to those people who required such services, and the nursing facilities received deficiencies. Down from 8.1% in 2001. 16.6% of nursing facilities failed to promote residents' care in a manner and in an environment that maintains or enhances the residents' dignity and respect for the individual resident, and the nursing facilities received deficiencies for violating the federal standard. Down from 17.3%in 2001. Quite obviously, citing nursing facilities with "deficiency" violations has not either deterred the nursing facilities from injuring residents or ensured any significant improvement. How many elderly and disabled persons have to be injured or killed before CMS takes this seriously? Steve Gold, The Disability Odyssey continues Back issues of other Information Bulletins are available online athttp://www.stevegoldada.comwith a searchable Archive at this site divided into different subjects.