The NY Times reported on a new report that indicates that lawsuits improve the quality of health care because providers learn from their mistakes. “New evidence, however, contradicts the conventional wisdom that malpractice litigation compromises the patient safety movement’s call for transparency. In fact, the opposite appears to be occurring: the openness and transparency promoted by patient safety advocates appear to be influencing hospitals’ responses to litigation risk.”
Lawsuits can also reveal errors that should have been reported but were not — medical providers notoriously underreport errors (although studies have shown that the threat of litigation is not responsible for this underreporting) and lawsuits may fill these gaps.
Experts agree that the best way to reduce medical error is to gather and analyze information about past errors with an eye toward improving future care. Full disclosure and transparency is the best way to improve safety and prevent injury. Several factors appear to have overcome resistance to transparency, including widespread laws requiring disclosure to patients. Hospitals have also found that disclosing errors to patients and offering early settlements reduces the costs and frequency of litigation.
The Arkansas Times reported a jury in Arkansas returned a unanimous verdict finding that the Greenbrier Nursing and Rehabilitation Center had been negligent in the care and treatment of Martha Bull. Bull was admitted March 28, 2008 for 30 days of short term rehabilitation. During the night of April 6, 2008 she was in severe pain, sweating and unable to have a bowel movement. Nothing was done. The next shift, she continued to complain. A physician was finally called at 2:20 p.m. April 7. He ordered her transferred immediately to an emergency room. The director of nursing received the fax at 3:34 p.m., but was leaving for the day. The nursing director failed to properly communicate the order. No one saw the fax or was aware of it til after she was found dead. Bull wasn’t sent to the emergency room. She screamed throughout the afternoon, so loudly that residents on other halls complained. She was found dead at 10:20 p.m. April 7. The faxed physician’s order was found the next day.
The jury found the nursing home guilty of negligence, medical malpractice and violation of resident’s rights. The poorly trained and overworked nursing staff failed to follow doctor’s orders for emergency services and treatment of severe abdominal pain. The jury awarded damages for pain, suffering and mental anguish at $5.2 million.
Even a frivolous and unsuccessful defense appeal will only be the beginning of a long road toward collection, if any. Defense counsel spent all the liability insurance coverage for legal costs and fees — $100,000 in this case. Defendants hired six different defense lawyers. The nursing home is controlled by Central Arkansas Nursing Centers, a private company headed by Michael Morton of Fort Smith. The individual nursing homes were organized as “freestanding limited liability corporations”, with licenses separate from physical property and small liability insurance policies through a self-insurance-style program based in Bermuda.
The nursing home fought the case for four years but as a trial strategy admitted in the early stage of the trial “that a mistake was made.” The admission of a mistake came only after the trial began. If sincere, it should have done so long ago, expressed regret and demonstrated sincerity by trying to make things right.
The Columbus Dispatch had an interesting report on the excessive cost of nursing home care.
When Teresa Horstman of Madison County in Ohio was concerned about her father who she says “lived his life with dignity” and was then suffering from dementia, she wanted him to have the highest quality of life. This prompted her to upgraded his assisted-living room to the most advanced care option offered at Springfield nursing home. However, Teresa feels that for the high price she was paying, her father was not getting the improved quality of care that he should. “Attention from the staff was lacking, she said. And, she recalls, a physician who made rounds there failed to respond to her repeated requests that Mr. Horstman receive a clinical evaluation of his condition.”
She says that her father worked his entire life, along with raising nine children and now his life savings are almost exhausted paying for a poor level of care. “He had to sell his belongings. Here we were draining his bank account so he could sit around at a home in poopy diapers.”
Nursing homes defend their prices saying since most resident require help with at least four or more daily activities including bathing, feeding, toileting, and transferring they receive a lot of services that are well worth the price. However, many nursing homes claim their prices are justified by the level of care they provide, however it is important to consider if residents are actually receiving the care they pay for.
Nursing homes say that due to a bad economy and a growing number of elderly individuals that are choosing to receive in-home care rather than move to a facility, the market is very competitive and they cannot continue to raise prices. Rather than increase the price and risk losing customers, nursing homes are finding other ways to cut cost such as cutting staff, often at the expense of their residents. Nursing homes decease their staff size and cut employee benefits to save money which compromises the level of resident care. This hurts residents who are not receiving the level of care they pay for since employees who are overworked and under compensated cannot preform their duties.
The Legal Examiner reported on the astounding number of medication errors occurring in nursing homes. Researchers from the Journal of the American Medical Informatics Association observed nursing home staff administering medication to 127 residents and found 428 errors, totaling an alarming 21.2 percent of all medication administrations. Another study reaffirmed these startling findings, showing that the repeated errors in nursing homes were a “common occurrence”and, obviously, were more likely to cause harm to residents than non-repeated errors.
Medication errors including giving the wrong dose of medication, giving it at the improper time, or incorrectly following doctor’s orders while administering the medication. While the amount of errors in long-term care nursing homes are alarmingly high, the American Journal of Geriatric Pharmacology found that rates are even higher in assisted-living facilities. This can be attributed to the fact that improperly trained, non-nursing staff is given the responsibility of administering medications. In another study the Journal of General Internal Medicine found that these errors “were the rule rather then the exception” and that many errors involved risky drugs such as hypoglycemic agents and anticoagulants.
Paul Woodley of Saratoga Springs, NY experienced the consequences of medication errors when his wife, who was a resident of Maplewood Manor Nursing Home, was mistakenly administered a dose of insulin intended for her roommate. As a result she suffered from dehydration, pneumonia, and an urinary tract infection until she died sixteen days later.
The American Association of Retired Persons reports that on average Americans age 75 and older typically take over 11 medications each day. With this many medications it is very important that nursing home staff are especially vigilant and correctly trained. Sadly, the current number of medication administration errors is very preventable and likely attributed to the under-staffing and lack of training provided to staff.
The Post and Courier reported that Charleston state senator Paul Thurmond introduced a bill to make it clear that families have electronic surveillance at their disposal in gauging loved ones’ quality of care. The measure would require state-licensed facilities to inform residents and their relatives of the tool. It also devises criminal penalties for anyone who interferes with the equipment, known colloquially as “granny cams.” The goal and purpose is to deter abuse abd fraud, and catch sexual predators.
Sen. Thurmond, R-Charleston, drafted the current bill that allows video to be used in criminal and civil courts. Thurmond said he modeled the measure after one that Oklahoma lawmakers unanimously approved. Texas, New Mexico and Maryland also allow video cameras. Since the early 2000s, about a dozen states have considered such measures.
The bill would require permission only from the resident featured, or from a legal representative.
Among its provisions, the law would penalize anyone who tampers with the cameras.
The Arbitration Fairness Act of 2013 was introduced in Congress. The House bill had 22 cosponsors and the Senate bill had 17 cosponsors to reintroduce the bill in the 113th Congress.
See press release from Take Justice Back.
•The AFA would eliminate forced arbitration in employment, consumer, civil rights, and anti-trust cases.
•The AFA would ensure that the decision to arbitrate is truly voluntary.
•The AFA would restore fundamental rights created by state and federal laws that are currently at risk of being wiped out by forced arbitration.
What can you do now? Please take the following actions today.
1. Contact your member of Congress today and tell them you support the legislation.
2 Send an email to Congress through Take Justice Back: http://ow.ly/kNOXh
3. Ask your friends and colleagues to act.
4 Share the Take Justice Back action item with them: http://ow.ly/kNOXh
5. Spread the word–Email the press release to your colleagues and media contacts.
6 Share this Facebook post: http://ow.ly/kNPpN
7 Retweet on twitter: http://ow.ly/kNP4F
Market Watch reported that EarlySense, the market leader in Proactive Patient Care Solutions™, announced the results of a multi-center clinical study demonstrating that the EarlySense system helps medical teams at rehabilitation centers to reduce patient falls as well as the number of patients transferred back to the hospital. The clinical data was collected from The Hebrew Home at Riverdale, NY and Dorot Medical Center in Israel. The data was presented today at the 2013 Annual Scientific Meeting of the American Geriatrics Society (AGS) by Hebrew Home medical director and study principal investigator Dr. Zachary J. Palace in a poster titled The Effect of a Continuous Patient Monitoring System on Reducing Hospitalization and Falls in Skilled Nursing Facilities. For additional information, please visit http://www.earlysense.com.
Dr. Palace said, “The implementation of EarlySense on the post-acute care units has demonstrated a significant decrease in the total number of falls and a trend towards reduction in the readmission rate back to hospitals, thus improving the overall quality of care for the elderly. The system also alerted regarding early warning signs of patient deterioration which enabled our medical team to proactively respond and literally save four lives. As clinicians we are always on the lookout for better ways to provide safer, more effective care for our patients.”
Dr. Palace continued, “Patient falls and subsequent hospital transfers are an ongoing challenge for most rehabilitation centers. The EarlySense system is the first technology to help us more effectively and proactively respond to early warning signs of deterioration and potential falls to secure better patient outcomes. We’ve experienced success and look forward to continuing this trend.”
Dorot Medical Center principal investigator Dr. Gad Mendelson said, “As the population ages, we are seeing a growing need to provide safer, smarter care without increasing our staffing level. In this clinical trial, we saw that the continuous monitoring nature of the EarlySense system and its low level of false alarms allowed our team to reach deteriorating patients earlier without creating alarm fatigue.”
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The Wall St. Journal reported that “some of the nation’s largest health-care landlords are pulling back from nursing homes on concerns they will be less profitable in an era of steep Medicare and Medicaid cuts.” Health Care REIT Inc., which leases to about 250 nursing homes nationwide, and Senior Housing Properties Trust, which is the landlord to nearly 50 nursing homes, have indicated they are greatly reducing their exposure or that they might exit the sector.
“Ventas Inc., one of the largest health-care landlords in the U.S., said it is comfortable with the approximately 300 nursing homes it already houses but won’t make major new acquisitions in the sector until there is more clarity on Medicare rates. Instead, Ventas plans to expand into assisted-living properties that aren’t dependent on government subsidies.”
REIT equity investors remain attracted to nursing-home landlords, in part because of their relatively high dividend yields. Health Care REIT’s share price is up 22.6% so far this year and it pays a dividend yield of 4%, higher than the 3.3% yield for the overall REIT sector.
These entitlement programs combined make up about 90% of nursing-home revenue. If they are diminished, some nursing homes could have difficulty paying their rent. Medicare pays for patients admitted for post-surgery rehabilitation for stays around 90 days or less. Medicaid, accounting for about 70% of most nursing-homes’ revenue, subsidizes longer stays for indigent elderly patients. The sequester will result in $11 billion in reduced revenue to Medicare providers. That is on top of an estimated $7 billion shortfall in Medicaid reimbursements nationwide last year, a 14.3% jump from 2011, according to the American Health Care Association.
Some nursing-home landlords say the market risk is overstated. If the sequester-induced cuts do occur, “We don’t believe it will have a big impact on the operators profitability,” said Craig Bernfield, chief executive and founder of Aviv REIT Inc., based in Chicago.
In a recent article by The Washington Post, the issue of how technology can help residents and caregivers were explored. There are several apps, programs, and tools that can help make life a little easier for caregivers.
Instead of a paper list of medications, time they should be taken, and refill times, a new app called Balance that allows users to create that list on their phones. The $3.99 app was released by the National Alzheimer Center. The medication list is just a part of what the app offers. It also provides caregiving tips, notes for doctor appointments, and a news feed about Alzheimer’s.
The Alzheimer’s Association has a program called Comfort Zone which is a tracking program. The person with Alzheimer’s wears a tracking device. As they go places, the data is sent to the program, which can be checked from a phone, an iPad, a computer, etc. The family member knows where the person is going. Tracking programs like these are especially useful because they provide freedom for people who don’t need to be under supervision. The tracking program allows family members to see the person’s patterns, and as the disease progresses, it can become clear that further action needs to be taken.
Autism Speaks has given iPads to low income families in an attempt to create better communication between autistic children and caregivers. There are a number of programs which can be used on the iPad and computer which help organize information about medicines, appointments, behavioral notes, etc. However, there are also programs designed to foster learning. Since many autistic children face issues with social communication and behavioral impairments, these devices can provide an outlet for their opinions and their thoughts without being physically taxing. iPads can also be a reward. When lessons are finished, children can play with the iPad or watch videos.
Vice President of the Alzheimer’s Association Beth Kallmyer suggests that we be cautious in moving forward with these tools. She believes that it’s too early to depend on these tools completely. As she says, the population affected with Alzheimer’s is the older generation and sometimes they don’t feel comfortable with this technology.
Technology is the next best thing to being there. At least that’s what some nursing home residents are saying. A new program which provides computers and services to residents is creating communication where previously there had been none. Using services like CanConnect, which is a Skype based program that uses larger buttons and a simpler interface, residents can call, video chat, and even attend events.
Where a resident might not be able to attend a wedding, using this technology, they can still be there. The program is also useful for families who live in different states. If a resident of a North Carolina nursing home has family in Charleston, SC, then the family won’t be able to visit as often as they might wish. Using these types of video interfaces, families who are miles apart can reconnect. See article at Citizens Voice.