In June, the Office of Inspector General (OIG) performed an audit documenting incidents of potential abuse and neglect at skilled nursing facilities, which cover not only the elderly but also disabled persons. The purpose of the report was to determine:

• The prevalence and incidence rate resulting in emergency room claims and high-risk diagnosis codes;
• Whether the incidents were reported in the correct and proper manner; 
• Whether the Centers for Medicare and Medicaid Services (CMS) and state survey agencies followed through on their duty to report any findings of abuse to the correct law enforcement officials; and
• The extent to which the CMS requires incidents like these to be recorded and tracked.

One in Five Claims Involve Abuse or Neglect

The OIG looked at close to 38,000 high-risk hospital ER claims for those receiving Medicare benefits and living in skilled nursing facilities throughout 2016. What they found was that 20 percent of high-risk hospital ER Medicare claims were the result of potential neglect or abuse. They also found that the facilities failed to report a number of these incidents to survey agencies and law enforcement in accordance with federal requirements and that the CMS does not require all potential abuse or neglect incidents to be reported to law enforcement and other agencies, nor do they track and record these incidents in their tracking system.

By law, these facilities are required to report all violations – even if just alleged – involving abuse or neglect to the Survey Agency. According to definitions provided by the CMS:

• Abuse is defined as the intentional and willful infliction of harm or punishing a resident in a manner that results in physical or mental harm
• Neglect refers to a situation in which healthcare providers fail to supply a resident with the necessary care in order to avoid harm
• An injury of an “unknown source” is an injury where 1) no one observed the source and it could not be explained by the resident and 2) there are suspicious circumstances involved due to the injury’s extent or location, the number of injuries present at one time, or the number of injuries present over time

The OIG’s Recommendations

As a result of the audit report, the OIG recommended that the CMS:

• Ensure that these incidents of potential abuse or neglect are identified imported;
• Work with survey agencies to improve staff training related to how to identify important incidents;
• Provide guidance in order to help identify potential abuse or neglect;
• Require that incidents of abuse and neglect be reported and tracked; and
• Monitor these findings over the long-term.

 South Carolina Nursing Home Abuse Attorneys

If you or a loved one has been subject to nursing home abuse, contact our experienced South Carolina nursing home neglect lawyers today to find out how we can help.

According to elder abuse statistics, approximately 10 percent of older adults experience some kind of abuse, usually from staff at care facilities. In addition, according to a new study published in the Journal of American Geriatrics Society, nurses are more likely to have to abandon necessary patient care in nursing home facilities that have insufficient staffing resources, and this is inevitably linked to poor care quality and increased adverse events.

There is no question that America’s nursing home crisis is going to get much, much worse, and this is especially going to be a problem if some of the county nursing homes end up having to close due to failure to raise Medicaid rates. If county nursing homes have to close, private nursing companies and their staff – especially their nurses – will inevitably be forced to expand and take on more, and this will inevitably lead to more neglect and abuse due to staff constraints. As a result, families have to be vigilant and monitor their loved ones for signs of harm in these facilities.

The Deadly Mistakes and Neglect that Come from a Shortage of Staffing

One of the most common issues that seniors face in these homes is neglect. This could be due to insufficient staffing, which can often result in poor care for residents, such as failing to properly bathe and feed them or rotate them in bed bedsores. This could also translate into medication errors. As a result, families should be on alert for signs of issues like bedsores or even over-medication.

 Specifically, according to the study, more than 70 percent of nurses had to miss one or more very important necessary care tasks on the last shift due to a lack of time and resources. The activities most frequently skipped included comforting patients, developing care plans, performing patient surveillance, speaking with patients, and teaching patients and families. This was especially an issue when nursing home nurses were dissatisfied with their jobs and/or experiencing burn out. 

Families should also be aware that these facilities are more likely to be understaffed on the weekends, especially want to comes to having fewer orderlies and nurses. During these times, patients are especially vulnerable to issues such as bedsores, medication errors, and failing to receive medical attention that they need. And while issues such as bedsores have been highlighted at these facilities, there are a number of issues that can be a lot subtler and more difficult to detect, such as bruises and bumps. In addition to looking for physical changes, also look out for changes in behavior, such as fear, depression, etc., as well as wandering.

Contact Our Florence Nursing Home Neglect Attorneys

If you live in South Carolina and have been injured or lost a loved one due to negligence in a nursing home, contact an experienced Florence nursing home abuse attorney today to find out how we can help.

Three reports that have been released just in the last month highlight very serious problems and concerns when it comes to America’s nursing homes. Specifically, a number of these homes are not only delivering poor but also outright dangerous, care that is largely hidden from the public and visitors. 

In addition, unfortunately, there doesn’t appear to be a lot that the government or states can do about it. Not only is the industry demonstrably resistant to government regulation and enforcement, but budget cuts are making it harder and harder for state and federal governments to respond to these bad actors, and this includes the federal Centers for Medicare and Medicaid Services (CMS).

Hundreds of Facilities Are Causing Problems

Facilities that have been designated as special focus facilities by the CMS are supposed to be subject to additional inspections — i.e. reviewed every six months – and made public on the CMS’s website. However, according to these reports, due to budget issues, the CMS can only designate 88 nursing homes nationwide as special focus facilities, regardless of how many patients are at risk at a number of other facilities. In other words, only when one is removed can a new one be added, and that leaves hundreds of facilities that are providing persistently poor care simply listed as “candidates,” and therefore not publicly identified or subject to additional oversight.

Hospices Are a Serious Part of the Problem

Unfortunately, hospices are no exception: According to internal government reviews, about 20 percent of hospices have at least one serious issue that places patients at risk of being harmed. In fact, most had what has been described as “serious” problems in terms of placing patients at risk over a number of years, indicating a long history of very poor care. In addition, according to the Office of the Inspector General (OIG), surveyors often fail to identify and cite hospices for more serious violations. Indeed, many don’t even report the crimes to law enforcement at all. 

Unfortunately, the CMS is also somewhat limited in terms of whether and how they can penalize hospices, which results in too much negligence. Specifically, the CMS reportedly does not have the power to impose intermediate penalties – they can only outright shut down facilities – which arguably discourages some surveyors from writing them up in the first place. In addition, while hospitals have to self-report any violations of rules, hospices do not, and while nursing homes and hospitals are often written up for paperwork problems, for example, it is not paperwork problems that are harming patients under their care.

Suggested Reforms

The Office of the Inspector General recommended a number of reforms for the CMS, including:

• Encouraging surveyors to report serious issues and crimes;
• Disclosing survey results on public websites;
• Making it easier for families and beneficiaries to file formal complaints;
• Requiring hospices to better educate and train staff to recognize abuse; and
• Strengthening requirements for hospices to report harm to patients.

Greenville, Florence, and Darlington South Carolina Nursing Home Abuse Attorneys

If you or a loved one has been subject to nursing home abuse, contact our experienced South Carolina nursing home neglect lawyers today to find out how we can help.