Auditors with the Health and Human Services inspector general's office drilled
down on episodes serious enough that the patient was taken straight
from a nursing facility to a hospital emergency room. Scouring Medicare
billing records, they estimated that in 2016 about 6,600 cases reflected
potential neglect or abuse that was not reported as required. Nearly
6,200 patients were affected.
"Mandatory
reporting is not always happening, and beneficiaries deserve to be
better protected," said Gloria Jarmon, head of the inspector general's
audit division.
Overall,
unreported cases worked out to 18% of about 37,600 episodes in which a
Medicare beneficiary was taken to the emergency room from a nursing
facility in circumstances that raised red flags.
Responding
to the report, Administrator Seema Verma said the Centers for Medicare
and Medicaid Services does not tolerate abuse and mistreatment and slaps
significant fines on nursing homes that fail to report cases.
Verma
said the agency, known as CMS, is already moving to improve supervision
of nursing homes in critical areas such as abuse and neglect and care
for patients with dementia.
CMS
officially agreed with the inspector general's recommendations,
including clearer guidance to nursing facilities about what kinds of
episodes must be reported, improved training for facility staff, and
requirements that state nursing home inspectors record and track
possible problems as well as incidents reported to law enforcement.
Neglect
and abuse of elderly patients can be difficult to uncover.
Investigators say many cases are not reported because vulnerable older
people may be afraid to tell even friends and relatives much less the
authorities. In some cases, neglect and abuse can be masked by medical
conditions.
The report cited
the example of a 65-year-old woman who arrived at the emergency room in
critical condition. She was struggling to breathe, suffering from kidney
failure and in a state of delirium. The patient turned out to have
opioid poisoning, due to an error at the nursing facility. The report
said a nurse made a mistake copying doctor's orders, and the patient was
getting much bigger doses of pain medication as a result. The woman was
treated and sent back to the same nursing facility. The nurse got
remedial training, but the facility did not report what happened. The
report called it an example of neglect that should have been reported.
The American Health Care
Association, which represents the nursing home industry, said in a
statement from its vice president for quality, David Gifford, that it
would "fully support more transparent reporting." The group said
Medicare's current definition of neglect "is vague and creates confusion
about what should be reported."
The
nursing facilities covered by the report provide skilled nursing and
therapy services to Medicare patients recovering from surgeries or
hospitalization. Many facilities play a dual role, combining a
rehabilitation wing with long-term care nursing home beds.
Investigators
said they faced a challenge scoping out the extent of unreported cases.
It wasn't like they could query a database and get a number, since they
were looking for cases that weren't being reported to state nursing
home inspectors.
To get their estimate, auditors put
together a list of Medicare billing codes that previous investigations
had linked to potential neglect and abuse. Common problems were not on
the list. Instead it included red flags such as fractures, head
injuries, foreign objects swallowed by patients, gangrene and shock.
The
investigators found a total of 37,600 records representing 34,800
patients. Auditors then pulled a sample of cases and asked state
inspectors to tell them which ones should have been reported. Based on
the expert judgment of state inspectors, federal auditors came up with
their estimate of 6,600 unreported cases of potential neglect and abuse.
Medicare
did not challenge the estimates but instead said that billing data
comes with a built-in time lag and may not be useful for spotting
problems in real time.
Separately,
the report also flagged potential problems with state nursing home
inspectors reporting documented cases of abuse or neglect to local law
enforcement. Federal auditors pulled a sample of 69 cases across five
states in which inspectors verified that nursing facility patients
suffered neglect or abuse. Only two were reported to local law
enforcement, although reporting is required.
In
one case, a male resident was sitting in the facility's dining room
when an employee walked by and pushed the back of his head, then kept
walking. The employee denied it, but his actions were captured on
surveillance video. The report said state inspectors verified what
happened but did not report it to local law enforcement.
Full Article & Source:
Watchdog: Thousands of cases of abuse and neglect in nursing facilities unreported despite federal rules
1 comment:
Interesting why state inspectors do not report the obvious abuse to authorities. Why would that be?
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