Skilled nursing facilities (SNFs) are the places you go to get physical therapy and other treatments to make a full recovery from a hospital stay, perhaps where you got a new hip or knee, or had complex surgery on your weak heart, or you recovered from a stroke or from pneumonia.
The SNFs should be safe, but far too often they become places where you get sick, according to the shocking findings in a government report issued in February. Something bad happened to 22% of the Medicare patients who went to a skilled nursing facility after a hospital stay. These “adverse events” included such things as medical errors-getting the wrong medicine, not getting the correct dosage, or infections from contaminated equipment infections. More than half the patients who suffered adverse events became so ill they had to go back to a hospital.
The SNFs simply aren’t doing their job of keeping Medicare patients safe and sound while they recover from a hospital stay, according to Toby Edelman, an attorney with the Center for Medicare Advocacy, a watchdog group for consumers.
“Much of the harm identified by the IG [inspector general] – residents’ falls, pressure sores, inadequately monitored medications leading to hospitalizations – is the result of facilities’ failure to provide care to residents that federal law mandates and has mandated since 1990,” according to Edelman. “CMS [Center for Medicare and Medicaid Services] needs to step up and fulfill its role as a regulatory agency to ensure, in the words of the 1987 Nursing Home Reform Law, that the Requirements governing care of residents, and enforcement of those requirements, are ‘adequate to protect the health, safety, welfare, and rights of residents and to promote the effective and efficient use of public moneys,” Edelman said.
The report, “Adverse Events in Skilled Nursing Facilities: National Incidence Among Medicare Beneficiaries,” was issued by the inspector general of the Department of Health and Human Services.
The report said it aims to “raise awareness of nursing home safety and seek to reduce resident harm through methods used to promote hospital safety efforts. This would include collaborating to create and promote a list of potential nursing home events—including events we found that are not commonly associated with SNF care—to help nursing home staff better recognize harm.” The OIG report said the federal government should instruct State agency surveyors to review nursing home practices for identifying and reducing adverse events.
It cost Medicare $2.8 billion in fiscal 2011 for hospital treatments for patients who suffered harm in the Skilled Nursing Facilities.
The toll for a single month, in August 2011, was 1,538 deaths in the SNFs, and 10,742 residents injured, the IG report said.
The SNFs are short-staffed, said Edelman of the Medicare Advocacy project. “The Inspector General found that many adverse events and harm incidents were caused by staff’s failures to monitor residents or provide prompt care, underscoring, once again, that staffing levels in SNFs are grossly inadequate. More registered nurses and more nursing staff in general are needed to provide residents with the care they need to function at the highest possible level.”
