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.

Bloomberg News had an interesting article on a recent study by federal health care inspectors which said U.S. nursing home industry overbills Medicare at least $1.5 billion a year for treatments patients don’t need or never receive. That is incredible.  The national for profit chains were the worse offenders.  78 percent of $105 billion in revenues went to for-profits in 2010, up from 72 percent in 2002.  The emergence of national for profit chains is fueling waste, fraud and patient harm in the $2.8 trillion U.S health care sector.

Thirty per cent of claims sampled from for- profit homes were deemed improper, compared to just 12 percent from non-profits, according to data Bloomberg News obtained from the inspector general’s office of the U.S. Department of Health and Human Services.

“The November study that found $1.5 billion in improper nursing-home bills — equivalent to about 5 percent of total Medicare outlays to the facilities — was by the U.S. Department of Health and Human Services office of inspector general.  It followed a 2010 OIG report that found for-profit nursing homes were nearly twice as likely as nonprofits to bill Medicare at the highest rate for patients of similar ages and diagnoses.”

Nursing homes employ more than 1.6 million workers, second only to hospitals in the health care sector, according to the Alliance for Quality Nursing Home Care, the trade group representing for-profit facilities.   Most of these workers are certified nurse aides who get no health benefits and are paid minimun wage.  Understaffing leads to burn-out, stress, and lashing out at residents.

The 10 largest for-profit nursing-home chains employed 37 percent fewer registered nurses per patient-day between 2003 and 2008 — and received 59 percent more deficiency notices from government inspectors — than nonprofits did, according to a study published last year in the journal Health Services Research.”

“At a nursing home in South Carolina owned by Life Care Centers of America Inc., an 80-year-old woman who couldn’t control her head or keep her eyes open was placed in a standing frame for 84 minutes of physical and occupational therapy just two days before she died — one in a number of Life Care overcharges for unnecessary care, according to civil fraud allegations filed in November by the U.S. Justice Department in federal court in Chattanooga.”

In a civil complaint unsealed last month, U.S. prosecutors accused Life Care of billing Medicare for unnecessary and sometimes harmful treatments at its 230 nursing homes between 2006 and 2012.

This is what happens when for profit chains put profits over people.

Other blogs have discussed this report here and here.

 

The Wall St. Journal reported on the new OIG Report about the common practice of overbilling in the nursing home industry.  Medicare fraud is rampant.

Hundreds of nursing homes overcharge Medicare every year for so-called skilled services, adding $1.5 billion in annual costs to the program, according to a federal report to be released Tuesday.

About one-fourth of Medicare bills from facilities examined in the report were incorrect. The majority of these claims involved so-called upcoding, where a nursing home or other provider inflates the cost of its bill to Medicare by claiming more intensive services were done than actually performed. In other cases, nursing homes provided treatments that were inappropriate.”

 

The Charlotte Observer reported that South Carolina is "ripe for corruption because of government secrecy, weak ethics enforcement, little disclosure of legislators’ finances and low accountability for legislative and executive branch members".  A nationwide analysis gives South Carolina failing grades in nine of 14 key categories, with the state faring especially poorly in public access to information and executive accountability.  Each state was graded on 330 standards for its laws, regulations and enforcement in state civil service management, accountability of the executive, legislative and judicial branches, state budget processes and other key areas.

The report was based on an 18-month investigation by the Center for Public Integrity and Global Integrity; nonpartisan, good-government groups.  Analysts interviewed hundreds of state officials and employees across the country, along with expert professors, lawyers, and advocacy group leaders.

Governor Nikki Haley is not the only problem.  The report said undue political influence in South Carolina extends far beyond the governor’s office.   “An undercurrent of fear and political interference bubbles throughout the state’s civil service, one that is shot through with cronyism and patronage,” said its section on South Carolina.  The report said there is little public accountability for members of the part-time General Assembly.  “Because of virtually nonexistent asset-disclosure laws in South Carolina, lawmakers are more than able to hide their wealth – and who is paying them – even when it would create a clear conflict of interest,” the study said.

 

 Citing “a pervasive antagonism toward the press at the upper reaches of government,” the report found: “There is no agency that enforces the Freedom of Information law or monitors the state government’s compliance with it. There is also no appeal process, relegating to the courts any problem a member of the public or press experiences in obtaining public information.

 

The L.A. Times reported that the price of drugs widely used by elderly Americans grew by almost double the rate of inflation from 2005 to 2009, according to a new study by the AARP.

The average retail price over the five-year period for the 469 drugs most often used by AARP members grew by 25.6%, compared to the 13.3% rise in inflation over the same period, according to the report.

The report also says that 406 of the 469 most commonly used drugs are used to treat chronic conditions and that the average cost of taking such medicines for chronic conditions was $1,152 higher in 2009 than it was five years earlier.

 

TheStarPress.com published an article discussing the lack of a requirement for nursing homes to keep track of fired nurses for incidents related to drugs.  The article referenced the case of Nurse Kathryn Sue Kennedy who was hired nine times by different nursing homes despite prior drug issues at each of her places of employments. After being diagnosed as an opiate abuser by the Indiana State Nurses Assistance Program (ISNAP), in 2007, Kennedy’s license was still renewed and she continued to work at nine different institutions with repeated offenses of drug abuse and stealing from patients.

In one incidence in 2010, Kennedy went to a patient’s house and stole Vicodin after reportedly coming to check the breathing machine. After being fired from her position, Kennedy was hired two weeks later as the Director of Nursing at Brookside Haven Care Center. Unfortunately, there is no law set in place that requires facilities to report the firing nurses and the reasons for the termination.

It is the duty and responsibility of the fired employee to inform her next employer.  Of course, they never happens because the nurse would not get thejob then.   In the past year more than 400 cases were filed against Indiana Nurses in which 85 percent were drug related incidents.
It is apparent that there is no accountability in this system, which allows Nurses with records to continue to work in nursing care despite prior drug incidents or terminations.
 

McKnight’s had an article about thenew GAO Report showing that The Centers for Medicare & Medicaid Services need to make serious improvements in the tools it uses to evaluate the quality of nursing home care.  The Government Accountability Office conducted an investigation to determine whether CMS was doing an adequate job in monitoring implementation of the Quality Indicator Survey process. The GAO found that CMS has not established quality measures or performance goals to evaluate if QIS objectives are being met.

Both the GAO and the Department of Health and Human Services recommended that CMS “routinely monitor the extent to which progress is being made in meeting the objectives of the QIS and systematic methods for monitoring and facilitating states’ efforts to implement the QIS.”

 

Barbie Nemeth of The Examiner wrote an article on the statistics of abuse in today’s nursing homes.  Experts agree that the recognition and reporting of abuse is under-reported because of cover-ups, failure to investigate, and many victims are demented.  The article references a new report that found one of every 700 United States nursing homes have been cited for physical, sexual and verbal abuse.  283 nursing homes were cited for abuse violations, according to a review of state inspection records.   Investigators said lots of violations are neither detected nor reported, leading officials to think the issue is underestimated. These homes were cited for 9,000 abuse violations from January 2009 to January 2012.  Over two times as many nursing homes were cited for abuse in 2010 than in 2009. In 2009 fifty nine percent of all nursing homes were cited for an abuse violation in the work of their annual inspections; in 2010, 16 percent of nursing homes were cited.  Roughly 1.5 million seniors live in nursing homes.

"They found examples of residents being punched, choked or kicked by staff members or other residents. It is a shocking reality for thousands of older Americans, a trend that was first reported last year with the story of Helen Love. She was attacked by a certified nurse’s assistant at a facility, who was angered she’d soiled herselfHelen Love died days after her interview. Her assailant got a year in county jail and a inquiry found that other employees at the same facility had been convicted for abuse, which ought to have barred them from working in a nursing home or with the elderly."

The Chicago Tribune reported the suspicious death of a resident after a fatal altercation with another resident at Oak Park Healthcare Center.  The nursing home failed to report the altercation to the health department for further investigation. Anibal Calderon, 80, died of head injuries after an alleged fight that took place.  Calderon’s death was ruled a homicide by the Cook County medical examiner’s office. The Illinois Department of Public Health is now investigating.

Under state law, the nursing home should have reported the incident immediately to the health department as well as to the family of the victim and local police. Federal regulations require that nursing home residents involved in violent incidents be removed from the facility if necessary for their safety and the safety of others.  State officials have no record that Oak Park Healthcare notified the health department, said spokeswoman Melaney Arnold.  The for-profit nursing home has 204 beds and an occupancy rate of about 75 percent, according to the state. 

Nursing homes are also required to make available for public inspection the five most recent years of survey materials that would list possible violations, according to the IDPH website. But the Tribune reporter was escorted out of the Oak Park facility after requesting to look at the documents.

 

Medpage Today reported that companies that administer Medicare Part D drug programs for seniors cannot tell whether antipsychotics and other drugs they cover are being used for medically accepted indications, according to a new report from the Department of Health and Human Services’s Office of the Inspector General (OIG). The investigation and report were a result of substantial concerns that nursing home residents are being over-prescribed atypical antipsychotics.

An OIG report earlier this year found that 14% of all nursing home residents with Medicare had claims for antipsychotics, and 88% of the atypical antipsychotics prescribed off-label were for dementia. More than half of all elderly nursing home residents’ Medicare claims for antipsychotics were made erroneously, the OIG found.

There are eight atypical antipsychotics approved by the FDA to treat schizophrenia and/or bipolar disorder, including clozapine (Clozaril), aripiprazole (Abilify), and quetiapine (Seroquel). None of them are approved to treat dementia and must carry black box warnings that elderly people who take atypical antipsychotics have an increased risk of death, compared with those who take placebo pills for dementia.

The report found that nursing homes were being reimbursed without documentation whether a drug was used for a medically accepted indication.

Sen. Herb Kohl (D-Wis.) asked witnesses at the hearing about the new report — all of whom were government officials or aging and nursing home experts — why antipsychotics are being so widely used to control behavior in nursing homes.

One witness, Toby Edelman, an attorney with the Center for Medicare Advocacy, pointed to understaffed nursing homes; high turnover of nursing home staff who don’t have time to get to know each patient; and to off-label marketing by drug companies who illegally promote the use of antipsychotics to doctors as a treatment for their elderly patients. Edelman also pointed to a decline in the use of physical restraints in nursing homes as a reason antipsychotic use in nursing homes has increased.

Dr. Jonathan Evans pointed to another more pervasive problem leading to overuse of the drugs among the elderly: The belief among doctors that medication is the first-line therapy for treating elderly adults with behavioral issues.

"There is a firm, fixed belief among many healthcare professionals that difficult or disruptive behaviors are causes for medication and that medication is likely be beneficial for that purpose," said Evans, who is the vice president of the American Medical Directors Association. "That belief is wrong."