In the third installation of our series of articles leading up to Mr. Abril’s teleconference presented by the National Business Institute next Monday, March 26, 2018, we’d like to include a non-reimbursement related subject which will be addressed in the teleconference.
Nursing homes and healthcare facilities have a duty to protect the safety and well-being of the patients and residents within their care. They must have written procedures in place to (a) identify “red flag” residents and (b) steps to report and stop the abuse.
Reference to a “red flag” resident or patient in a nursing home setting refers to a patient who has been subject to either abuse or neglect. This abuse is typically at the hands of staff members/caretakers but could possibly extend to family members or other residents of the nursing home.
Nursing home negligence can be broken down into categories but typically comes down to intentional economic decisions made at the institutional level that seems to center around poor staff hiring and training or an administrative decision to hire far fewer staff members than is reasonable. Business profit enhancement in nursing homes—filling more beds while reducing capital output—naturally compromise the quality of patient care.
The major red flags that indicate abuse or neglect are as follows:
- Pressure ulcers (“bed sores”): the byproduct of a bed-confined patient who is not being moved or altered in their position sufficient to maintain proper blood circulation. Bed sores can be deadly as they are often the first step towards gangrene and the need for amputation. There is no tolerable level of pressure ulceration on a patient, thus these are almost always strong supporting evidence of patient neglect.
- Dehydration: dehydration can result in renal failure and indicates a lack of attention on a patient.
Moderate red flags:
- Fewer staff: a reduction in staff, below the typical staff to patient ratio, means less people to take care of patients and more opportunities for neglect or even abuse.
- Increase in staff turnover: employee turnover in the nursing home industry is a global issue. Working with the elderly can be draining and unrewarding, at times. Staff turnover means new and often times less trained staff working with patients. It can also reflect economic cost-saving decisions by management.
- Quality of staff appears to be reducing: this could also be related to an institutional decision to cost contain and replace higher paid, experienced workers with lower paid and less experienced ones. In these circumstances, the patient care is most compromised by this decision.
- Declining morale of staff: staff cutbacks, increased responsibilities and less money make for a less pleasant workplace and increases the odds that patient care will suffer.
- Patient group and individual activities lessen: outgoing and engaged staff members who organize events, outings or activities in nursing homes often make the difference in the quality of life for the patients. If that seems to be effected, this might reflect efforts to generally cut back on overhead, staffing or the quality of staff being hired and needs to be carefully watched.
- Decreased food quality: nursing home cooking includes many dietary restrictions for patients and can be a complex undertaking. Decreased quality of food could be a sign of concerning cost containment efforts.
- Declining Cleanliness and Hygiene Standards: cleanliness and hygiene at a nursing home are critical to patient wellbeing. Staffing quality and quantity are clearly the most vital considerations that reflect whether steps are being taken to maintain these health standards.
“Red flag” patients in a hospital setting typically refer to patients exhibiting drug seeking behaviors in pursuit of unnecessary opioids or narcotics. It was estimated in 2012 that up to 20% of emergency department patients may be due to drug-seeking behavior. Given the present opioid epidemic facing the United States, it stands to reason that this estimation will have dramatically increased between 2012 and 2018. Healthcare facilities must adopt a systematic approach in order to identify drug-seeking patients:
- Involve the entire team: observe how a patient behaves in the parking lot as they are approaching the ED, in the waiting room and as they leave. Be sure to check prior physicians and medical history as well.
- Recognize suspicious behavior, such as:
- Rating their pain as 10 out of 10 or even greater
- Requesting intravenous pain medication
- Reporting a non-narcotic allergy
- Requesting a brand-name medication
- Obtain a thorough history of present illness
- Look for consistency in the exam
- Conduct appropriate tests
- Prescribe nonpharmacological treatment: a patient unwilling to try these therapies is unlikely to desire an improved level of function.
- Proceed cautiously: physicians have a dual obligation to relieve a patient’s pain and also to protect susceptible patients from abusing or becoming addicted to drugs.
One major challenge in treating pain in an ED setting is that chronic narcotic use can make patients more sensitive to pain. Though they are exhibiting drug-seeking behavior, they may truly be suffering from the most severe pain possible though it is impossible to determine if the care they’re seeking is just an attempt to get medications for non-therapeutic reasons.
For more information about “red flag” identification and reporting procedures, please tune into Mr. Abril’s teleconference on teleconference titled “Recovering Debts for Nursing Homes and Healthcare Facilities” presented by the National Business Institute March 26, 2018, from 2:00 pm – 3:30 pm EST.