Wound Care

In June, I wrote on the increasing legal actions being taken against nursing facilities. These lawsuits usually are filed by family members who feel a facility did not provide proper care. However, some attorneys also are seeking potential plaintiffs. Defending these actions, settling out of court or appealing huge jury awards carries a large price tag. I estimated in that column that the cost of legal defense or fiscal penalties imposed for deficiencies will exceed the cost of using specially formulated skin care products or durable medical equipment designed for residents at risk for pressure ulcers. Judging from the response I received, the home medical equipment (HME) industry agrees.

While families will continue to take legal action, the Health Care Financing Administration (HCFA) has launched a campaign to protect nursing home residents. There are two components of this initiative. The first is aimed at the nursing facilities and the care provided. New regulations allow states to recommend civil monetary penalties of up to $10,000 per incident rather than on a per-day basis. The amount assessed will depend on the severity of the deficiency or noncompliance and the facility's history of problems. In the past, nursing facilities were given a grace period to correct problems before a fine was imposed. With the new rule, the penalty applies immediately. HCFA is considering another option that would allow states to recommend a daily penalty of up to $3,000 if authorities revisit after an initial survey and find that a deficiency has not been corrected.

Providing greater authority to the states allows strong enforcement penalties when nursing facilities continue to violate health and safety requirements.

The survey process now strongly focuses on preventing pressure ulcers, malnutrition and abuse. HCFA requires surveyors to ask persons involved in providing care to residents with pressure ulcers what they believed caused the ulcer. And here are the facts driving this:

  • a recent study at a Michigan medical center revealed a 63 percent reduction in pressure ulcer
  • development when the staff was trained on prevention and treatment
  • pressure ulcer citations are constantly in the top 10 most cited deficiencies
  • pressure ulcer litigation has cost facilities hundreds of thousands of dollars in claims and legal settlements

The second component of HCFA's initiative is a national educational campaign for the public. HCFA is asking nursing facilities to display posters and other materials to help residents and their families identify and report incidents of abuse and neglect. Physical signs of abuse that should be reported include bruises, scratches, fractures, fearful behavior, weight loss and dehydration. Additional education for consumers and nursing home staff about the risks of malnutrition and dehydration will start later this year.

In addition, Nursing Home Compare, a national database of nursing home inspection reports at www.medicare.gov/nursing/home.asp is available on the Internet. It allows the user to find the results of the most recent survey for any facility in the country. The site includes summary information about the problems found in a particular facility. It is as easy to use by selecting a state and searching for nursing homes in by name, city, zip code or county. Families can examine the record of a facility where a relative resides, or they can compare information on a number of nursing homes in a particular area. HCFA plans to enhance Nursing Home Compare by adding information about staffing levels and the condition of residents in each home. Since the site began in September 1998, it has been used more than any other section of HCFA's consumer web site.

Another web site allows nursing home administrators and caregivers to share successful efforts to improve care for residents. Sharing Innovations in Quality (SIQ) is developing a repository of professional standards/guidelines in long-term care that have improved outcomes for nursing home residents. Among the issues addressed are skin integrity, incontinence, and nutrition and weight loss. The address of this site is www.hcfa.gov/medicaid/siq/siqhmpg.htm.

HCFA also has produced a video that provides tips for selecting a nursing home. It is available through state ombudsmen, survey agencies, and consumer advocates and in some video stores. A newly revised "Guide to Choosing a Nursing Home" is another resource aimed at the general public. It includes questions to ask, a nursing-home checklist, contact information and other resources.

Let's hope that better education ultimately leads to better care!

This article originally appeared in the September 1999 issue of HME Business.

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