The U.S. Department of Health and Human Services (DHHS) Office of Inspector General has issued an important new report: New York Did Not Always Verify correction of Deficiencies Identified During Surveys of Nursing Homes Participating in Medicare and Medicaid (A-02-15-01024)(October 2017). As a result of its examination of complaints and response data from 2014, the DHHS Office of Inspector General estimated that in 72% of these cases, the state did not obtain or collect sufficient evidence the nursing homes in question addressed these deficiencies. (Of the 70 deficiencies for which the State was required to obtain documentation/evidence of correction, information was inadequate for 51 of them.)
A 2016 study of the Sandy disaster response finds that people with diabetes were at special risk: “Emergency visits for a primary diagnosis of diabetes had an increased frequency of certain co-morbidities, including hypertension, recent procedure, and chronic skin ulcers. Patients with a history of diabetes visited EDs in increased numbers after Hurricane Sandy for a primary diagnosis of myocardial infarction, prescription refills, drug dependence, dialysis, among other conditions.” And it concluded that “there is a need to support diabetic adults particularly in the week after a disaster by ensuring access to medications, aftercare for patients who had a recent procedure, and optimize their cardiovascular health to reduce the risk of heart attacks.” This is consistent with the concerns raised by Patient & Family, the Center for Independence of the Disabled New York, the New York Statewide Senior Action Council and others after Superstorm Sandy. More vigilance is needed to make sure New York does better in the next severe weather disaster.
On November 7, 2016, the implementation of a new rule forbidding nursing homes that enter binding arbitration agreements with residents from participating in the Medicare and Medicaid programs has been blocked by a U.S. District Court judge. The judge issued a preliminary injunction against enforcement of the rule, pending an appeal brought by various nursing home groups, including the American Health Care Association. They are arguing that the federal Centers for Medicare & Medicaid Services (CMS) did not have authority to issue the new regulation. Until the legal battle is resolved, the rule will not be enforced.
The federal Center for Medicare and Medicaid Services has issued substantial new regulations to protect the safety and healthcare rights of nursing home residents. The changes include:
- A ban — currently not enforceable because of a preliminary injunction pending an appeal of this part of the new regulations — on forced arbitration agreements in nursing home contracts, prohibiting the use of pre-dispute binding arbitration agreements. This part of the rule is suspended until resolution of a legal challenge.
- Training requirements for long-term care facility staff members in caring for residents with dementia and in preventing elder abuse.
- Ensuring that long-term care facilities take into consideration the health of residents when deciding how many staff and what kinds of staff are needed to properly take care of its residents.
- Improving care planning, including discharge planning.
- Allowing dietitians and therapy providers to write orders within their areas of expertise if a physician delegates the responsibility and state licensing laws allow.
- Updating the long-term care facility’s infection prevention and control program, including requiring an infection prevention and control officer and an antibiotic stewardship program with antibiotic use protocols and monitoring of antibiotic use.
The final rule is available on the Federal Register at https://www.federalregister.gov/public-inspection.
Superstorm Sandy revealed to us that our healthcare system was not prepared for disasters. On Sept. 8, 2016, the federal Centers for Medicare and Medicaid Services (CMS) issued new federal disaster preparedness regulations for healthcare facilities that take Medicare or Medicaid. The rules take effect 60 days from that date and apply to healthcare facilities that take Medicare or Medicaid. Healthcare providers will have a year to develop and implement:an emergency all-hazards plan, with policies & procedures and annual trainings/drills, plus a communications plan. Find out about your local hospital or nursing home’s planning process. http://bit.ly/2cKRroB
The Institute for Patient- and Family Centered Care holds a prestigious international conference annually. This year, because of its partnership with Patient & Family in a project to improve policies on family presence in hospitals in New York City, the 7th Annual International Conference on Patient- and Family-Centered Care: Partnerships in Care, Interprofessional Education and Research will be held at the New York Marriott Marquis in Manhattan on July 25-27, 2016. We are proud to be working with the Institute on a project funded by the United Hospital Fund.
Manual lifting of patients and nursing home residents causes injuries every year to nurses and other bedside care workers while also putting patients at risk of falls, bruises and skin tears. OSHA has determined that manual lifting of people cannot be done safely even with the best methods. Modern technology exists to safely lift people. And in New York, a new law (The Safe Patient Handling Act) requires hospitals and nursing homes to develop programs with the goal of eliminating manual lifting of patients and nursing home residents. The NYS Department of Health has now issued its advisory Safe Patient Handling Best Practice Guideline for hospitals and nursing homes to carry out New York’s important new law on safe lifting and moving in healthcare.
Patient & Family is now serving — together with representatives from hospitals, nursing homes, nurses associations and others — on the NYS Department of Health “Safe Patient Handling Work Group” to develop recommendations to the Department for effective implementation of New York’s important new law on safe lifting and moving in healthcare, with which all hospitals and nursing home must come into compliance. The work group report will be issued this summer.
Patient & Family, NYPIRG and the NY Statewide Senior Action Council are urging hospitals and nursing homes to comply in good faith with a new law — adopted as part of the State Budget — on safe lifting and moving in healthcare.
Tucked inside the state budget recently passed in Albany is an important measure for patient safety, one that could reduce injuries for hospital patients, nursing home residents and healthcare workers. The new law requires hospitals and nursing homes to develop plans to ensure safety when patients or nursing home residents need help in moving about or being repositioned, such as in a chair or bed for comfort or to prevent bedsores. While we are praising the measure as an important first step, we are also cautioning that the new law’s impact will depend on hospitals and nursing homes to comply with the law in good faith. Read our press release here.
The Risk Management Quarterly, a journal of the Association for Healthcare Risk Management of New York, has published an article in its Fall 2013 issue by New Yorkers for Patient & Family Empowerment entitled, “Safe Lifting and Moving in Healthcare: An Emerging Trend of Caring Technology.” It cites the leadership of the U.S. Veterans Health Administration and several states in promoting safer lifting and moving in healthcare (often called “Safe Patient Handling”) through an initiative that combines the use of modern equipment with training and engagement of direct care staff. Citing federal studies and an analysis by the Fiscal Policy Institute, it concludes that the result of such programs is improved safety for both patients and healthcare staff, as well as substantial cost savings for hospitals and nursing homes. Maintaining a program is a challenge, and lack of accountability means a program can atrophy and no one outside the facility will know, leaving the public unprotected. Our article urges healthcare facilities to engage healthcare workers and also patients and nursing home residents in planning and evaluating safety programs. It also provides a useful list of questions a facility can ask to obtain feedback from its patients or residents regarding its lifting and moving practices. Read more.