Nurs­ing home abuse not flagged

The Columbus Dispatch - - Front Page - By Ri­cardo Alonso-zaldivar

WASH­ING­TON — Nurs­ing fa­cil­i­ties have failed to report thou­sands of se­ri­ous cases of po­ten­tial ne­glect and abuse of se­niors on Medi­care even though it’s a fed­eral re­quire­ment for them to do so, ac­cord­ing to a watch­dog report re­leased Wed­nes­day that calls for a new fo­cus on pro­tect­ing frail pa­tients.

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 mem­bers, 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 Jar­mon

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 an 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 beds.

To get their es­ti­mate, au­di­tors put to­gether a list of Medi­care billing codes that pre­vi­ous in­ves­ti­ga­tions had linked to po­ten­tial ne­glect and abuse. The list cov­ered such red flags as frac­tures, head in­juries, for­eign ob­jects swal­lowed by pa­tients, gan­grene and shock.

The in­ves­ti­ga­tors found 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 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 said the billing data comes with a built-in time lag and may not be use­ful for spot­ting problems in real time.

Sep­a­rately, the report flagged po­ten­tial problems with state nurs­ing home in­spec­tors. 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.

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