Not all nursing homes are well managed. How can you keep your loved ones safe?
When a loved one is too old or sick to care for themselves, many families consider putting the patient in a nursing home or rehab facility which can provide 24-7 medical attention for their loved one. However, putting a loved one in a facility is a big, often overwhelming decision. Of course, you want them to be safe and comfortable. The problem is, some of these facilities are better than others. I am sure you have all heard stories about staff neglecting and/or abusing elderly nursing home patients. How common are issues at nursing homes and rehab facilities? How do you pick the right place?
Before we go into this topic further, I want to clear up some terminology. Nursing homes are sometimes referred to as skilled nursing facilities. There are more than 15,000 skilled nursing facilities in the US, 90% of which are also certified as nursing homes. Skilled nursing services include wound care, IV therapy, injections, physical therapy, and the monitoring of vital signs and medical equipment. Staffing generally consists of RNs (registered nurses), LPNs (licensed practical nurses), and CNAs (certified nursing assistants), as well as specialists such as physical, speech and occupational therapists.
What kinds of issues should you worry about?
Nursing home patients are vulnerable and often unable to speak up for themselves, which can lead to safety and health issues, which can be categorized as follows:
- Quality of Care/Treatment – Insufficient or incorrect medical care, including delays or failures in care, medication errors, inadequate monitoring, preventable blood clots, excessive bleeding and kidney failure. Quality of care issues can lead to worsening health and sometimes unexpected deaths.
- Resident Neglect – Staff may ignore patient needs, including not providing timely incontinent care, not providing adequate food and liquids, inadequate care of bedsores that lead to infections, and improper patient handling which can lead to falls.
- Resident Rights – The denial of patient rights includes not allowing patients to refuse or delay any medication or treatment, not allowing patients to leave their room, and denying requests to move to another facility.
- Physical Environment – Patients may suffer due to environmental issues, including inadequate heating and/or cooling.
- Resident Abuse – Patients can suffer physical and/or sexual abuse by staff or fellow patients.
- Other – This category includes a wide variety of issues, including financial abuse, infection control, and misappropriation of property.
According to a report published by the US Department of Health & Human Services (HHS), between 2011 and 2015, of the complaints that were categorized as “immediate jeopardy” or “high priority”, 42% were related to quality of care or treatment.
When analyzing all of the complaints filed in 2015, the most common allegations involved:
- 41% – Quality of care or treatment
- 12% – Resident neglect
- 8% – Resident rights
For more information on elder abuse, visit the National Center on Elder Abuse website.
How common are complaints against nursing homes?
The HHS report states that the number of complaints filed against nursing homes has increased. It’s disheartening to learn that although “the number of nursing home residents decreased slightly between 2011 and 2015, the number of nursing home complaints States received increased 33 percent, from 47,279 to 62,790. Over this 5-year period, the number of complaints that States received per 1,000 nursing home residents increased from 32.7 to 44.9 complaints per year.”
How serious are these issues?
Another study by the HHS found that 1/3 of patients in skilled nursing facilities were harmed in treatment. The study evaluated records of 653 Medicare patients at more than 600 facilities. Of these 653 patients, 22% suffered events that led to lasting harm, and an additional 11% suffered temporary harm. In 1.5% of the cases, the patient died from poor care.
Based on these findings, the study estimates that across the US there would be almost 22,000 patient injuries and more than 1,500 deaths in a single month. This reflects a higher rate of medical errors than in hospitals.
Why aren’t these facilities safer?
Many residents of nursing homes have physical and/or cognitive impairments, requiring high levels of attention and care. Since it is financially impossible to provide one staff person for every patient, CNAs, LPNs and RNs can end up with unmanageable workloads.
Nursing home employees are often underpaid. Staff members may not develop emotional bonds with their patients due to high turnover rates and/or the use of staffing agencies. When you consider these challenges, it’s really no surprise that staff may neglect or abuse nursing home residents.
Furthermore, like any business, some facilities are better than others.
Medicare annually inspects these facilities, with additional inspections required when they receive serious complaints. Medicare has tough safety standards, but they are not uniformly enforced. Some inspectors are tougher than others, and some states do not conduct their onsite investigations in a timely manner when serious complaints have been filed. In fact, the HHS report found that almost 1/4 of the states did not meet Medicare’s performance threshold for timely investigations.
How can you evaluate a facility?
There are many websites where you can evaluate nursing homes and rehab facilities, including a site run by Medicare (visit the Zaggo Resource Center for a list of other websites). It’s important to consider the number of complaints filed against a particular facility. Clearly, the more complaints filed against a particular facility, the higher the risk of abuse or neglect.
The Centers for Medicare & Medicaid Services (CMS) keeps a list Special Focus Facilities (SFF) – nursing homes with a history of serious quality issues. These facilities have more problems than other nursing homes (about 2x average), have more serious problems than most others (including patient harm or injury), and have a pattern of serious problems that has persisted over at least 3 years. Find the May 2019 list here. Additionally, CMS published a list of facilities that are candidates for SFF classification – see that list here.
It is also very helpful to ask doctors and friends for recommendations. Lastly, after you have narrowed your list, it’s important to visit these facilities in person. While walking around you can get a sense of how the staff treats patients, the demeanor of the staff (are they smiling or scowling?), how well staff cares for the patients, in addition to the cleanliness and overall ambiance of the facility.
Items to consider when evaluating a facility include:
- Number of staffing hours per resident per day
- Ratings for quality of nursing
- Average tenure of staff (RNs, LPNs, and CNAs)
- Use of a staffing agency vs direct employees
- Quality of resident care measures, including statistics on the percentage of residents who:
- Go to the emergency department and/or hospitalized
- Report moderate to severe pain
- Experience one or more major falls
- Develop a urinary tract infection or bed sores
- Lose control of bowel and/or bladder
- Have a catheter inserted and left in their bladder
- Are physically restrained
- Have lost the ability to move independently
- Have lost too much weight
- Show signs of depression and/or anxiety
- Health inspection results
If you have a loved one in a nursing home, it pays to visit often. Not only will your loved one appreciate your time and attention, but your regular presence alerts the staff that family (and friends) are watching over the patient and will likely notice issues of neglect and/or abuse.
What should you do if you suspect an issue?
If you suspect staff is neglecting and/or abusing your loved one, do everything possible to move him/her to another facility.
Take detailed notes regarding the suspected abuse/neglect, take photos, and gather medical records. File a formal complaint with the state, which must investigate complaints of a serious nature if they receive the complaints within the required time frame. If the state classifies your complaint as “immediate jeopardy”, the law requires an onsite investigation within 2 working days. If they categorize your complaint as “high priority”, they have 10 working days to conduct an onsite investigation.
By filing a complaint, you can help stem the cycle of abuse and neglect. To learn how to file a complaint with the state where the facility is located, visit the National Center on Elder Abuse state directory, or search online with the name of the state and the phrase “filing a complaint against a nursing home”.
NOTE: I updated this post on 6-4-19.