A watchdog report released recently called for new focus on protecting nursing home patients. The report shows that nursing home facilities have regularly chosen not to report thousands of serious cases of potential neglect and abuse of seniors who receive their health care through Medicare even though it is a federal requirement for them to report.
Auditors with the U.S. Health and Human Services Inspector’s General Office drilled down on episodes that were serious enough that the patient was taken straight from the nursing home to a hospital emergency room.
The data that revealed this alarming reality was done by scouring Medicare billing records. It was estimated that in 2016, about 6,600 cases of potential neglect or abuse were not reported as required. Nearly 6,200 patients were affected.
“Mandatory reporting is not always happening, and beneficiaries deserve to be better protected,” according to the head of the inspector general’s audit division. Overall, unreported cases of nursing home abuse or neglect totaled 18% of about 37,600 episodes in which a Medicare beneficiary was taken to the emergency room from the nursing home in circumstances that would have raised red flags as to whether there was nursing home abuse or neglect.
The report gave rise to a response from the administrator of the Center for Medicare and Medicaid Services (CMS), Seema Verma, who stated that the Center for Medicare and Medicaid Services does not tolerate abuse and mistreatment of nursing home patients and has in the past slapped significant fines on nursing homes that failed to report cases.
According to Ms. Verma, 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.
An Associated Press report stated that CMS officially agreed with the inspector general’s recommendations to ramp up oversight by providing clearer guidance to nursing homes about what kinds of episodes must be reported, improving training for facility staff, requiring state nursing home inspectors to record and track all potential cases and monitoring cases referred to law enforcement agencies.
The cases of neglect and abuse of elderly patients is often times 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, about the circumstances in which they may have been abused or neglected. In some cases, neglect and abuse cases may go unreported because of the medical conditions of the nursing home resident.
In one case, a 65-year-old woman arrived at the emergency room in critical condition struggling to breathe, suffering from kidney failure and in a state of delirium. As it turned out, the patient was having these difficulties due to opioid poisoning because of an error at the nursing home. The report said a nurse made a mistake copying a doctor’s order, and the patient was getting much larger doses of pain medication as a result.
After being treated, this woman was returned to the nursing home. As a matter of fact, in this case, the nurse received remedial training, but the nursing home did not report what happened. This is an example of what was highlighted in this report generated by the auditors of the Health and Human Services Inspector’s General Office.
The report included nursing facilities covered by skilled nursing and therapy services for Medicare patients recovering from surgeries or hospitalizations. Many nursing homes also played a dual role, combining a rehabilitation wing with long-term care nursing home beds.
In order to make the estimates that were reported, auditors put together a list of Medicare billing codes that previous investigators had linked to potential neglect and abuse. Common problems were not always on the list. Instead, it included red flags such as fractures, head injuries, foreign objects swallowed by patients, gangrene and shock.
Kreisman Law Offices has been handling nursing home abuse lawsuits, nursing home neglect cases, nursing home bed sore cases and long-term nursing home lawsuits for individuals, families and loved ones who have been harmed, injured or died as a result of the carelessness or negligence of a medical provider at a nursing home for more than 40 years in and around Chicago, Cook County and its surrounding areas, including Bellwood, Bolingbrook, Romeoville, Joliet, Waukegan, Aurora, Geneva, St. Charles, Naperville, Wheaton, LaGrange, Palos Hills, Tinley Park, Oak Forest, Chicago (Wicker Park, Logan Square, Lakeview, Lincoln Square, Rogers Park, Albany Park, Kenwood, Bronzeville, South Shore, Lake Calumet), Inverness, Long Grove, Wilmette and Elmhurst, Ill.
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