The information published on preventing pressure ulcers seems limitless. With all of the available information, the incidence of new ulcers and untoward consequences – infection, greater depth and dehydration – of existing ones should be much lower than current statistics suggest. If recent nursing facility survey reports and the lawsuits brought against facilities is any indication, the industry is failing miserably.
The General Accounting Office (GAO) analyzed national inspection data from nursing homes in California, Michigan, Pennsylvania and Texas following an initial report citing widespread poor quality of care in California nursing homes. Findings indicated that 27 percent of nursing homes had health and safety violations resulting in actual harm to residents or posing the potential for serious injury. Forty percent of the nursing homes showing these serious problems in earlier inspection reports had equally serious deficiencies in their latest inspections. One of the most frequent violations was inadequate prevention of pressure ulcers.
The Senate Special Committee on Aging heard witnesses testify about abuse and neglect against nursing facilities, and committee chair Sen. Charles Grassley intends to continue the investigations. The Health Care Finance Administration (HCFA) has also announced a final rule that gives regulators more flexibility to impose stiff monetary penalties for these violations.
Further evidence that things are amiss is the increase in litigation related to quality of care issues and pressure ulcers. One jury awarded $83 million to the family of a nursing home resident who died from dehydration and infected pressure ulcers. Attorneys stress that staff and owners must be active in prevention because litigation against nursing facilities is going to increase.
Both the number of claims against nursing homes and the cost of these claims have risen significantly in the last four years. The average dollar amount paid out has also increased. For example, in 1996 one insurer’s average claim for a violation of resident rights was $43,200. In 1997 it had jumped to $159,000. It is the company’s third most costly claim. California, Florida, Ohio and Texas have the most litigation against nursing facilities and the highest awards. There are an estimated 500 cases pending against nursing facilities in Florida alone.
Facilities get into regulatory and legal trouble when a resident’s medical record is missing documentation or when the documentation is inconsistent or conflicting. For example, when facilities fail to document that a nursing policy on preventing pressure ulcers was followed or fail to address a negative outcome, such as a new ulcer, they are putting themselves at risk. Simply applying a dressing does not constitute quality care. Facilities need to question:
- What caused the incident to occur?
- What are the risk factors of the resident?
- How are the risks being minimized?
- What is being done to prevent further deterioration?
The best defense against survey citations and litigation is, of course, good, quality care. A facility must not only include clinical practice guidelines and up-to-date care approaches in policies, but it also must ensure that a certain level of care is achieved. A comprehensive risk-management program and strong, preventive practice go hand in hand. The quality assurance process should identify high-risk residents and study any incidence of new ulcers, including where they happen in the facility and why. The next step is taking remedial action.
The cost of good care, including using preventive products, costs less than making mistakes. If a survey results in a monetary penalty or a resident’s family files a lawsuit, the true cost of care is certainly greater than what a piece of equipment or good skin care products would have cost. Are we winning the battle against pressure ulcers? It seems like we still have a long way to go.
