DHHS: 1 in 3 nursing home stays failed to meet Medicare standards

For years we've heard horror stories about what goes on in some nursing homes and assisted living facilities. The examples of nursing home neglect that appear far too routinely in the press are disturbing, which may be why the Department of Health and Human Services' inspector general's office recently performed a study of whether nursing homes receiving Medicare funding are living up to the legal standards of care Medicare requires.

Unfortunately, the answer was no in about a third of cases. The study, which looked at a statistically representative sample of nursing home stays taking place in 47 states in 2009, found evidence of serious issues in care management, some of which put patients in danger.

Beyond the human cost of nursing home neglect, DHHS estimates that Medicare paid about $5.1 billion that year for substandard care. The sample studied corresponds to about 1.1 million patient visits to nursing homes nationwide.

Most nursing homes accept both Medicare patients and those with other means of payment, but if they accept Medicare, they have to comply with the law. That means these findings affect Medicare and non-Medicare patients alike.

The biggest issue was apparently that many nursing facilities failed to create appropriate, individual care plans for every patient as required by law. These care plans are necessary because they ensure that every member of the health care team knows the patient's current treatment plan, goals and progress.

Unfortunately, all too often DHHS found that there was no care plan, an inadequate plan, or a plan that wasn't being followed.

Around 20 percent of the time, patient health problems weren't addressed in the care plan at all. For example, one patient studied was on an anti-depressant and two anti-psychotic drugs that could have serious side-effects, but nothing was in the plan about monitoring those medications.

In nearly a third of cases, nursing homes failed to make adequate plans for patient discharge or transfer. They failed to provide enough information for follow-up treatment when patients were transferred to another facility or to for successful home care.

In many cases, patients' care plans weren't followed, perhaps due to greed. The report specifically called attention to the fact that it was in the nursing homes' financial interest to provide or continue treatment patients didn't need. For example, one patient continued to receive occupational and physical therapy even though the care plan stated that all the health goals were already met.

The report did not list the nursing homes studied or the number of patients harmed by neglect. All of the offending facilities, however, were forwarded to the Centers for Medicare & Medicaid Services for action.

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