January 2011 Archives

January 25, 2011

Study Finds Unnecessary Treatments for Dementia Patients Drive Up Medicare Costs


As a Pennsylvania nursing home lawyer, I was interested to see a study saying unnecessary treatments may be one reason for the growing cost of caring for the elderly. As the New York Times New Old Age blog reported Jan. 21, a study published in the Archives of Internal Medicine found that some of the most expensive treatments for late-stage dementia patients are also the most unnecessary ones. These included hospitalization and related after-care. In fact, author Dr. Susan Mitchell said in addition to being avoidable, these hospitalizations can be traumatic and confusing for dementia patients and may make them uncomfortable when antibiotics are used.

Mitchell and her colleagues at the Hebrew Senior Life Institute for Aging Research studied Medicare spending for 300 patients in greater Boston over 18 months. The largest share of the spending, 30 percent, went to hospitalization; 10 percent more went to skilled nursing administered after the hospital. Many hospitalizations were for pneumonia or related respiratory problems, which are common problems for dementia patients. However, Mitchell said, about 75 percent of the hospitalizations were for ailments that could have been treated just as well in the nursing home. In addition to being less expensive, leaving the patient in the home could also avoid the emotional trauma to patients who don't understand why they're being moved. And in patients near the end of their lives, palliative care may be preferred by some, the post said. Mitchell added that nursing homes may hospitalize patients they can treat on-site to shift costs from Medicaid to Medicare, which pays higher rates.

Any unnecessary medical treatment is a bad sign to me, as a Philadelphia medical malpractice lawyer. In addition to being expensive and traumatic, sending patients to the hospital unnecessarily puts them at risk of infection, medication mistakes and other problems that can arise from a change in caregivers. Even the emotional trauma can have significant effects on a patient with already compromised health, and physical injuries could send that patient into a health decline that could even end in death. If Mitchell is right that nursing homes do this to make a bit of extra money, that's even worse -- because it explicitly puts the nursing home's profits ahead of the best interests of the patients, their families and the taxpayers. Patients who believe their loved ones have been used as pawns in this way should talk to a Philadelphia injury lawyer right away.

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January 19, 2011

Study Finds Health Care Underfunded by Medicaid in Pennsylvania and Other States


As a Philadelphia medical malpractice lawyer, I was interested to see a recent report on the ongoing funding problems for nursing homes that accept Medicaid. The American Health Care Association, a nonprofit long-term care trade group, released a study last week showing that nationally, state Medicaid programs underpaid nursing homes by $5.6 billion. That works out to a national payment of $7.17 per hour per patient, which the AHCA points out is below the current minimum wage. The states with the seven biggest funding shortfalls included Pennsylvania, at number six, and neighbors New York, New Jersey and Ohio.

The study (PDF) was commissioned by AHCA and performed by private company Eljay LLC. It puts Pennsylvania's projected funding deficit for 2010 at $15.13 per hour per patient. The deficits come from the difference between the "allowable costs" for Medicaid services and what Medicaid pays homes. The actual cost of providing nursing home services might exceed Medicaid allowable costs, the report said, which means the shortfall might be even bigger. This is a major issue for nursing homes because Medicaid makes up about 64 percent of their funding, along with Medicare, long-term care insurance and private payment. A separate study published in the Archives of Internal Medicine found that nursing homes eliminated about five percent of their beds between 1998 and 2008 because of budget cuts, with a disproportionately high number of those beds disappearing in communities with high percentages of minorities or poverty.

This issue is interesting to Pennsylvania nursing home lawyers like me because funding has a direct effect on the quality of care patients receive. If, for example, nursing homes choose to let go of staff members, those staff members have less time to spend with each individual patient, and may be tempted to leave more often for higher-paying jobs elsewhere. The results can be disastrous, including patients allowed to wander without supervision, staff members who don't notice bedsores or other problems, distracted aides who mix up drugs and overworked staff members giving inappropriate dementia drugs just to keep patients cooperative. These and other cutbacks can expose patients to unacceptable Pennsylvania nursing home abuse, which means adequate funding for elder care must be a priority.

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January 12, 2011

Wilkes-Barre Police Find No Evidence for Nursing Home Patient's Sexual Assault Claim


As a Philadelphia injury lawyer, I was interested to see a story about an unsubstantiated claim of sexual abuse in a Pennsylvania nursing home. The Times Leader of Wilkes-Barre reported Jan. 12 on an investigation into a claim by a 91-year-old woman that she was sexually assaulted by two other women. According to the article, investigations by the city police department and the home itself could not substantiate the patient's claim. The police said they are still investigating but don't expect charges to be filed.

The accuser, who was not named, lives at Riverstreet Manor in Wilkes-Barre. According to the article, she accused two women of sexually assaulting her several weeks ago. No more details were reported. A spokesperson for the home said the home has a zero tolerance policy for abuse and undertook its own investigation, as well as contacting the local police and the health department. They were unable to turn up any evidence that the assault took place, the spokesperson said. The home has also been in contact with the accuser's family, who the spokesperson said were pleased with the way the home handled its investigation.

As a Pennsylvania nursing home lawyer, I hope these investigations came to the right. Sexual abuse is a grave accusation at a nursing home and has resulted in high-profile criminal prosecutions in other states. It's possible that the woman's accusations couldn't be substantiated because they sprang from a mental problem such as dementia. Unfortunately, people who truly are abusing nursing home patients often rely on patients' physical or mental illnesses to keep them silent, or dispute their claims if they speak up. That's why it's important for nursing homes to take all allegations of Pennsylvania nursing home abuse seriously, even when they come from unreliable people.

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January 4, 2011

Article Reminds Pennsylvania Nursing Homes to Beware of Spreading Viruses in Winter


As a Pennsylvania nursing home lawyer, I know nursing homes can be a breeding ground for disease outbreaks when staff members aren't careful. So I was very interested in a Dec. 29 article in the Allentown Morning Call reminding nursing homes and hospitals that we've entered the worst time of the year for noroviruses. Norovirus is the scientific name for the type of virus that causes gastroenteritis, known more colloquially as stomach bugs. In the first three months of 2010, the Pennsylvania Patient Safety Authority said, nursing homes reported nearly twice as many cases of norovirus as they did for the entire rest of the year. Outbreaks are also a risk at hospitals, the article noted, but the risk is much higher at nursing homes. Hospital outbreaks affected an average of six people, the authority said, whereas nursing home outbreaks affected an average of 25.

Norovirus is spread by fecal contamination of food and water, person-to-person contact or contact with contaminated surfaces. Part of the reason outbreaks are more common in nursing homes, said the article, is that people live in nursing homes, often in close quarters. That means they can't easily be quarantined, the way they could in a hospital. In addition, the article noted, a norovirus tends to affect nursing home patients more dramatically. In healthy adults, infection means 2-3 days of vomiting, diarrhea and general misery. In older people, this can cause life-threatening dehydration and be complicated by any underlying health problem. Not surprisingly, experts say the best way to prevent outbreaks is by washing hands thoroughly and wiping down surfaces often. Many nursing homes also ask workers to stay home until they are completely recovered from illness.

As a Philadelphia medical malpractice lawyer, I know these are the same guidelines that health care facilities -- including nursing homes -- should always implement. The reminder is important, however, because it's very easy for staff members to cut corners when they don't see the danger. Failure to wash hands, wipe down tables, change sheets, etc. often enough isn't just unpleasant to look at or think about -- it can actually cause serious health problems in a population of older and sick nursing home patients. For someone with a compromised immune system, a norovirus that a healthier person might shake off can lead to hospitalization or even death.

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