According to the February 2014 report from the U.S. Department of Health and Human Services Office of Inspector General (“OIG”) entitled, “Adverse Events in Skilled Nursing Facilities: National Incidence Among Medicare Beneficiaries,” five physicians were contracted to review the medical records of 362 Medicare beneficiaries that was based on a random sample of 653 Medicare beneficiaries who were discharged in August 2011 and who met certain other stated criteria.
The physician-reviewers determined the following regarding the root causes of preventable adverse events in nursing homes based on the medical records of the nursing home residents that they evaluated (an “adverse event” is defined as harm resulting from medical care, including the failure to provide needed care):
The 5 Most Common Preventable Nursing Home Adverse Events
1. Appropriate treatment was provided in a substandard way. The physician-reviewers determined that 56% of the preventable events involved appropriate treatment that was nonetheless provided in a substandard way. As an example, the researchers noted one resident who suffered an undiagnosed pneumothorax (collapsed lung) because the nursing home staff failed to recognize symptoms of shoulder pain and shortness of breath. The nursing home resident later had two additional events (a reaction to medication and a blood clot), both requiring transfer to a hospital.
2. The resident’s progress was not adequately monitored. The physician-reviewers determined that 37% of the preventable events involved inadequate monitoring of the resident’s progress.
3. Necessary treatment was not provided. The physician-reviewers determined that 25% of the preventable events occurred because necessary treatment was not provided to the nursing home resident.
4. Error was related to medical judgment, skill, or resident management. The physician-reviewers determined that 14% of the preventable events were due to errors in medical judgment, skill, or resident management.
5. Resident care plan was inadequate. The physician-reviewers determined that 11% of the preventable events were due to inadequate care plans.
The physician-reviewers further determined that 66% of medication events were preventable, 57% of resident care events were preventable, and 52% of infection events were preventable.
They also found that 22% of Medicare beneficiaries experienced adverse events during their nursing home stays, resulting in prolonged nursing home stays or hospitalizations, permanent harm, life-sustaining intervention, or death. An additional 11% experienced temporary harm events.
(We use the term “nursing home” whereas the OIG’s report uses the term “SNF,” which is defined as a facility engaged primarily in providing skilled nursing care and rehabilitation services for residents who require such care because of injury, disability, or illness. Nonetheless, 90% of SNFs are dually certified as both SNFs and nursing homes (i.e., long-term care providers), and so the distinction makes little, if any, difference.)
If you or a loved one experienced an adverse event or other harm during a nursing home stay, you should promptly consult with a local nursing home claim attorney in your U.S. state who may investigate your nursing home claim for you and represent you in a nursing home case, if appropriate.
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