Nursing facility safety questioned in HHS report

An estimated 22% of patients at skilled-nursing facilities experienced preventable injuries, such as medication errors, falls and infections, and had to stay longer in the hospital, according to a new report from HHS' inspector general's office (PDF). More than half of the residents who had been harmed required hospitalization at a cost of an estimated $208 million to Medicare, the report found.

“Our study confirms the need and opportunity for skilled-nursing facilities to significantly reduce the incidence of events,” wrote the authors in the report, which looked at more than 650 Medicare beneficiaries who were admitted to a skilled-nursing facility in August 2011 and stayed for 35 days or less. Though the analysis only looked at one month, the authors say if those rates remained constant throughout the entire year, it would mean that about 60% of Medicare residents at these facilities, or more than 19,000 people, were hospitalized at least once due to preventable adverse events, an expenditure of about $2.8 billion in 2011 alone.

The authors offer recommendations on collaborative measures the Agency for Healthcare Research and Quality and CMS could use to raise awareness about nursing home safety and reduce resident harm. They suggest, for example, the creation of a list of potential events to help nursing home staff better recognize harm; a review of nursing home practices by state surveyors; and encouraging nursing homes to report adverse events to patient safety organizations, among other measures.

Several professional associations weighed in, one calling the report a thoughtful assessment of an “environment of misadventures.”

“This report should serve as a springboard for a national discussion on the care of frail elders and how it can be improved,” responded the AMDA (PDF), the professional association representing long-term-care facilities, in a news release.

In 2013, the AMDA recommended CMS adapt its Physician Quality Reporting System to help address quality concerns in skilled-nursing and other post-acute long-term-care facilities.

There's a lack of data surrounding harmful events within this setting, the association contended. The HHS report offers a “useful framework” for determining where care can be improved and policies can be implemented. Patient advocate groups also responded, saying the report highlights a national failure in protecting some of the most vulnerable patients.

The skilled-nursing facility setting is often “the perfect storm of medical harm,” wrote Dr. Julia Hallisy, founder and president of the Empowered Patient Coalition, a not-for-profit consumer advocacy group based in California. The report reinforces that there is still a lot of work to do, she said, and suggested taking measures even further than the report recommends in terms of reporting adverse events to patient safety organizations.

“I would suggest that we go much further and publicly report adverse events as we have started to do with hospitals,” Hallisy said. “Accountability is crucial if we are to make a real difference in patient safety in skilled-nursing facilities.”

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