Nursing Home Complaints Rose by 33% over Four Years

From McKnight's Long Term Care News: complaints filed against nursing homes between and including the years 2011 and 2015 were up by a third, according to a federal report. 

In 2011, there were 47,279 complaints, which had risen to 62,790 by 2015, notes the new report from the Office of Inspector General Report from the Department of Health and Human Services.  More than half were prioritized as high priority or resulting in immediate jeopardy, triggering  onsite investigations within 10 working days. A third of complaints were substantiated, according to the OIG.

The increase in complaints may not reflect declining care quality, authors suggested, but instead, may reflect better options for filing and  tracking the reports.  For those concerned with care quality, however, the increase in complaints suggests that, even if care quality is not decreasing, care quality remains a significant challenge.  More than half of complaints related to quality of care/treatment or resident/patient/client neglect. Examples given included a lack of blood glucose strips for a patient with high blood sugar who was later found deceased, and a resident who called for assistance after a bowel movement and wasn't helped until three and a half hours later.

The summary of the Report reads:

"State survey agencies must conduct onsite investigations within certain timeframes for the two most serious levels of complaints-those that allege serious injury or harm to a nursing home resident and require a rapid response to address the complaint and ensure residents' safety. However, previous reports by OIG and the Government Accountability Office found that States did not conduct onsite investigations within the required timeframes for some of these complaints.

Each year, half of all nursing home complaints were at the level of seriousness that requires a prompt onsite investigation, and the most common allegations among these related to quality of care or treatment. During the period we reviewed, States conducted nearly all the required onsite investigations. Although almost all States conducted most of their onsite investigations within required timeframes, a few States fell short. Furthermore, almost one-quarter of States did not meet CMS's annual performance threshold for timely investigations of high priority complaints in all 5 years. Lastly, States substantiated (i.e., verified with evidence) almost one third of the most serious nursing home complaints.

Tennessee accounted for most of the immediate jeopardy complaints in the five-year period, the report says. Additionally, Tennessee, Arizona, Maryland and New York accounted for almost half of the high priority complaints not investigated onsite within 10 working days.

To read the Report, click here.  To read the OIG's summary and explanation of the Report, click here.

To learn how your estate plan might facilitate "Aging in Place," click here. 

Aging in Place: CMS Reports Success in Reducing Medicare Cost for Long-term Care Residents by Reducing Hospitalizations

Infringing on the autonomy of Medicare patients to seek quality care is paying off in massive dollar savings for the federal government.   This blog previously reported on the controversial sign-off rule that prevents Medicare patients discharged from hospitals to nursing facilities from returning easily to the hospital for necessary care.  Before the rule, if you were discharged to a nursing home, but later felt that hospital care was necessary, you could simply ask to be transported back to the hospital.  Your wife, your health care proxy, or the nursing home could transport you back to the hospital.

After implementation of the rule, not even the nursing home, if it believes the hospital  is better able to care for you, can return you to the hospital, unless there is a life-threatening condition, or a doctor first examines you and "signs off" on the the transfer.   The nursing home industry objected to this hard-to-justify restriction on its authority and discretion. 

Since 1984, the federal policy of reducing the hospital stays of Medicare patients, which some have characterized as "quicker and sicker," has increasingly transitioned elderly health care from hospitals to highly regulated skilled nursing facilities in order to reduce the cost of Medicare.  There is increasing evidence that there are significant resulting adverse outcome outcomes.  Now, the federal government implies that these same facilities cannot be trusted to make decisions regarding choice of care. Physicians are relegated to gatekeepers for more expensive care, even where necessary. 
   

In the first assessment since the controversial rule was implemented, the Centers for Medicare & Medicaid Services (CMS) reported that the rate of potentially avoidable hospitalizations among dual-eligible long-term care residents fell by nearly a third in recent years.  In a data brief posted on the CMS blog, officials documented the “real progress” made in reducing cases of potentially preventable hospitalizations among long-term care residents over the last decade. Overall, the hospitalization rate for beneficiaries eligible for both Medicare and Medicaid — including those outside of long-term care facilities — fell 13% between 2010 and 2015.

In that same five-year timespan, the rates of hospitalizations among dual-eligible long-term care residents caused by potentially avoidable conditions, such as dehydration, urinary tract infections and skin ulcers, dropped 31%. That decrease was widespread, with improvement documented in all 50 states. In total, the decrease meant dually-eligible residents avoided 133,000 hospitalizations between 2010 and 2015.  The brief does not, however, report that the overall incidence of avoidable conditions decreased — only that hospitalizations for the conditions decreased.    In fact, the only reported reduction in incidence (i.e., improvement in actual health outcomes), appears to have come from the Agency for Healthcare Research and Quality (AHRQ) Safety Program for Long-Term Care, which "significantly reduced catheter-associated urinary tract infections in hundreds of participating long-term care facilities nationwide."  This 2001 project helped prevent a recognized cause of hospitalizations in residents of these facilities.  One can assume that the absence of reported reductions in other potentially avoidable conditions means that there was no significant reduction attained.

CMS is applauding its ability to reduce expensive hospitalizations, but is tacitly acknowledging that these weren't achieved by better quality care, but rather from impediments and disincentives to more expensive, higher quality care. There is nothing in the recent report that suggests overall  improvements in healthcare outcomes for the nation's elderly.     

Blog authors Niall Brennan, chief data officer for CMS, and Tim Engelhardt, director of CMS' Federal Coordinated Health Care Office, attributed the decrease to the “committed work by those who directly serve older adults and people with disabilities,” as well as programs such as the agency's “Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents.” The post also highlighted CMS' Hospital Readmission Reduction Program, Accountable Care Organizations and bundled payments as drivers behind the hospitalization rate drop.

This article was inspired by an article in McKnights, the original of which can be found here.