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The price tag will be preventable deaths, a disproportionate number of which will be deaths of elder patients. Three years ago the HHS Inspector General estimated 180,000 patients per year die as a result of poor hospital care; this estimate is three years old and was conservative in 2010.
However, if a close friend or family member requires skilled care outside of home, the risk is magnified by receiving care in a skilled nursing facility. One out of every three of patients will be injured or will die in such a facility. The number is staggering, considering there are 15,000 skilled nursing facilities in this country. Here is a link to the Pro Publica website. The following article concerns skilled nursing facilities. By all accounts, including the estimate of Medicare's Inspector General, 22, 000 injuries per month will occur (more than 1,500 fatal.) According to Medicare nearly sixty per cent of these cases could be prevented:
http://www.propublica.org/article/one-third-of-skilled-nursing-patients-harmed-in-treatment
Predictably representatives of America's huge, growing, nursing home industry answer by protesting any suggestion that insufficient light shines on the quality of care patients receive in their facilities. They claim government inspection is vigorous. Clearly annual inspections, however vigorous, are ineffectual. One suggestion by Johns Hopkins makes sense. It is to develop metrics to track improvement, as an adjunct or alternative to annual inspection.
"...a system of long-term care that’s trying to retrofit to be a system for post-acute care. The resources to care for (these patients) and commitment from those sending them from one facility to another haven’t kept pace." -Dr. Jonathan Evans, president of the American Medical Directors Association
Consumers know nursing facilities have to deal with Medicare itself; it is a given. Medicare payment is a significant part of the problem; it is both insufficient and slow. However, this has not slowed industry growth, so skilled nursing facilities must be profitable. Are nursing homes beleaguered by underpay and overwork? I believe it is likely. Are they places where people work purely for love and concern for their patients? I think this is a gross exaggeration. In any event, it is no consolation to injured or dead patients or their loved ones.
In addition industry representatives decry abbreviated hospital stays, alluding to the original intent of nursing homes. Their facilities were intended to provide care for medically stable patients, but they currently admit many patients whose hospital stays have been cut short, too short. Assuming this is not buck-passing, the healthcare system is failing miserably to assign joint accountability in what it calls the continuum of care.
Richard Mallot, Executive Director of New York’s Long Term Care Community Coalition characterizes skilled nursing facilities as "dangerous, dangerous places. " He believes the industry entirely capable of addressing the staggering numbers of medication errors, bedsores (infections) and falls experienced by patients. He does not fault Medicare's standards of care, stating standards of care are poorly enforced.
As families and friends of patients, we are on our own, left to advocate for people we love. To begin be certain the condition of the patient warrants dismissal from the hospital. Before choosing a care facility, check Pro Publica's Nursing Home Inspect, for information about available skilled nursing facilities: http://projects.propublica.org/nursing-homes/
Once a patient has been admitted to a skilled nursing facility, keep a close watch on the patient, If necessary, enlist a team to be present randomly and regularly for the patient. Never dismiss anything a patient says. Advocate with medical staff, the patient's primary care physician, and nursing home management. Promptly contact an ombudsman, as well as your state's oversight agency, if you deem a problem to be ongoing.
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