by Stephen Louis Krasner
Inundated
with medical information, health updates and making decisions while
serving as a caregiver to a seriously ill person is a tough position to
be in for anyone. When it results in the loss of that person while being
under the premise they would recover — the shock can be devastating.
Misleading Names and Messaging
It
is reasonable to believe that most people would infer that upon the
discharge of a patient from a hospital and into a skilled nursing
facility (SNF) that they would be on the road to rehabilitation and
recovery — heading home in the not too distant future. This is due in
large part to information provided to caregivers upon plans made to have
a patient admitted there.
A great number of these facilities have the word “rehabilitation” in their name — a look at New York’s statewide directory lists 622 facilities
— with over half of them having “rehabilitation” in the title. Hence
the very name of these places is misleading to some extent when evidence
suggests a significant number of patients entering these facilities
meet adverse outcomes — and never make it back home.
You Can Never Go Home Again
A study published in the journal Annals of Surgery examined
the outcomes of patients admitted to these facilities in five states,
being California, Florida, New York, Texas and Washington. It concluded
that 41% of patients discharged into a skilled nursing facility never
returned home.
It is often communicated to patients and families that discharge to an SNF is a step in the process of recovery, and because clinicians have very limited evidence about the natural history of patients discharged to SNFs, patients may be given an unreasonable expectation of return to home. This study demonstrates that a significant proportion (41%) never returns to home, and the 1- and 3-year risk of death is much greater than that in the general population.
Looking
through the data in such a study brings up the question as to what
other factors outside this study might also be contributing to large
numbers of patients not making it home again. Examining the quality of
care people are receiving, and the variables at play behind that care,
provides some answers.
Money Versus Mission
Comparing
these types of centers by looking at the non-profit sector versus those
operating in the private sector is disconcerting.
In a 2018 report published in the journal Gerontology,
findings involving for-profit nursing homes raise several red flags. In
commenting on the report its lead researcher, Lee Friedman, stated the following:
We saw more — and more serious — diagnoses among residents of for-profit facilities that were consistent with severe clinical signs of neglect, including severe dehydration in clients with feeding tubes which should have been managed, clients with stage 3 and 4 bed sores, broken catheters and feeding tubes, and clients whose medication for chronic conditions was not being managed properly.
The
motivations behind the nursing facilities in each sector likely play a
role in the quality of care and qualifications of the staff working
there — especially when one considers mission driven work versus the
goals of profit driven work.
Touching
on this Friedman said, “For-profit nursing facilities pay their
high-level administrators more, and so the people actually providing the
care are paid less than those working at nonprofit places. So staff at
for-profit facilities are underpaid and need to take care of more
residents, which leads to low morale for staff, and it’s the residents
who suffer.”
With upwards of 70%
of these types of facilities falling in the for-profit ownership
category — one has to wonder as to the extent negligence plays a role
for those patients that are never able to go home.
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