Medicare Takes Aim At Boomerang Hospitalizations Of Nursing Home Patients

Deborah Ann Favorite binds a sketch of her mother, Elaine Essa. A nursing home and Essa’s primary caring use paid to settle a lawsuit brought by a family.

Heidi de Marco/Kaiser Health News

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Heidi de Marco/Kaiser Health News

Deborah Ann Favorite binds a sketch of her mother, Elaine Essa. A nursing home and Essa’s primary caring use paid to settle a lawsuit brought by a family.

Heidi de Marco/Kaiser Health News

“Oh my God, we forsaken her!” Sandra Snipes pronounced she listened a nursing home aides scream as she fell to a floor.

She landed on her right side where her hip had recently been replaced. She cried out in pain.

A sanatorium clinician after detected her hip was dislocated.

That was not a customarily damage Snipes, afterwards 61, pronounced she suffered in 2011 during Richmond Pines Healthcare Rehabilitation Center in Hamlet, N.C. Nurses allegedly had been injecting her twice a day with a manly blood thinner notwithstanding created instructions to stop.

“She said, ‘I only feel so tired,’ ” her daughter, Laura Clark, pronounced in an interview. “The nurses were observant she’s vexed and wasn’t doing her exercises. we pronounced no, something is wrong.”

Her children also detected Snipes’ surgical wound had turn putrescent and filthy with insects. Just 11 days after she arrived during a nursing home to reanimate from her hip surgery, she was behind in a hospital.

The tumble and these other purported lapses in caring led Clark and a family to record a lawsuit opposite a nursing home. Richmond Pines declined to plead a box over observant it doubtful a allegations during a time. The home concluded in 2017 to compensate Snipes’ family $1.4 million to settle their lawsuit.

While a connection of complications in Snipes’ box was extreme, lapse trips from nursing homes to hospitals are distant from unusual.


With hospitals pulling patients out a doorway earlier, nursing homes are deluged with increasingly thin patients. But many homes, with their sometimes-skeletal medical staffing, mostly destroy to hoop post-hospital complications — or emanate new problems by not seeing or receiving accurate sanatorium and medicine instructions.

Patients, held in a middle, might suffer. One in 5 Medicare patients sent from a sanatorium to a nursing home boomerangs behind within 30 days, mostly for potentially preventable conditions such as dehydration, infections and remedy errors, sovereign annals show. Such rehospitalizations start 27 percent some-more frequently than for a Medicare race during large.

Nursing homes have been unintentionally rewarded by decades of colliding supervision remuneration policies, that gave both hospitals and nursing homes financial incentives for a transfers. That has left a many exposed patients mostly ping-ponging between institutions, wreaking massacre with patients’ care.

“There’s this observant in nursing homes, and it’s unequivocally unfortunate: ‘When in doubt, boat them out,’ ” pronounced David Grabowski, a highbrow of health caring process during Harvard Medical School. “It’s a short-run, cost-minimizing strategy, nonetheless it ends adult costing a complement and a particular a lot more.”

In new years, a supervision has begun to tackle a problem. In 2013, Medicare began fining hospitals for high readmission rates in an try to diminish beforehand discharges and to inspire hospitals to impute patients to nursing homes with good lane records.

Rule Change Could Push Hospitals To Tell Patients About Nursing Home Quality

Starting this October, a supervision will residence a other side of a equation, giving nursing homes bonuses or assessing penalties formed on their Medicare rehospitalization rates. The idea is to accelerate early signs of progress: The rate of potentially avoidable readmissions forsaken to 10.8 percent in 2016 from 12.4 percent in 2011, according to Congress’ Medicare Payment Advisory Commission.

“We’re better, nonetheless not well,” Grabowski said. “There’s still a high rate of inapt readmissions.”

The revolving doorway is an unintended byproduct of long-standing remuneration policies. Medicare pays hospitals a set rate to caring for a studious depending on a normal time it takes to provide a standard studious with a given diagnosis. That means that hospitals effectively distinction by progressing liberate and remove income by gripping patients longer, even nonetheless an aged studious might need a few additional days.

But nursing homes have their possess incentives to hospitalize patients. For one thing, gripping patients out of hospitals requires visit examinations and rapid laboratory tests — all of that supplement costs to nursing homes.

Plus, many nursing home residents are lonesome by Medicaid, a state-federal module for a bad that is customarily a lowest-paying form of insurance. If a nursing home sends a Medicaid proprietor to a hospital, she customarily earnings with adult to 100 days lonesome by Medicare, that pays more. On tip of all that, in some states, Medicaid pays a “bed-hold” fee when a studious is hospitalized.

None of this is good for a patients. Nursing home residents mostly lapse from a sanatorium some-more confused or with a new infection, pronounced Dr. David Gifford, a comparison clamp boss of peculiarity and regulatory affairs during a American Health Care Association, a nursing home trade group.

“And they never utterly get behind to normal,” he said.

‘She Looked Like A Wet Washcloth’

Communication lapses between physicians and nursing homes is one repeated means of rehospitalizations. Elaine Essa had been holding thyroid remedy ever given that gland was private when she was a teenager. Essa, 82, was vital during a nursing home in Lancaster, Calif., in 2013 when a hitch of pneumonia sent her to a hospital.

When she returned to a nursing home — now named Wellsprings Post-Acute Care Center — her alloy wanting a essential instruction from her acknowledgment order: to resume a thyroid medication, according to a lawsuit filed by her family. The nursing home telephoned Essa’s alloy to sequence a medication, nonetheless he never called them back, a fit said.

Without a medication, Essa’s ardour diminished, her weight increasing and her appetite dead — all indications of a thyroid imbalance, pronounced a family’s attorney, Ben Yeroushalmi, deliberating a lawsuit. Her doctors from Garrison Family Medical Group never visited her, promulgation instead their helper practitioner. He, like a nursing home employees, did not grasp a means of her decline, nonetheless her thyroid condition was prominently remarkable in her medical records, a lawsuit said.

Serious Nursing Home Abuse Often Not Reported To Police, Federal Investigators Find

Three months after her lapse from a hospital, “she looked like a soppy washcloth. She had no tone in her face,” pronounced Donna Jo Duncan, a daughter, in a deposition. Duncan pronounced she demanded a home’s nurses check her mother’s blood pressure. When they did, a administrator ran over and said, “Call an ambulance right away,” Duncan pronounced in a deposition.

At a hospital, a medicine pronounced tests showed “zero” thyroid hormone levels, Deborah Ann Favorite, a daughter, private in an interview. She testified in her deposition that a alloy told her, “I can’t trust that this lady is still alive.”

Essa died a subsequent month. The nursing home and a medical use staid a box for trusted amounts. Cynthia Schein, an profession for a home, declined to plead a box over observant it was “settled to everyone’s satisfaction.” The fit is still ongoing opposite one other doctor, who did not respond to requests for comment.

Dangers In Discouraging Hospitalization

Out of a nation’s 15,630 nursing homes, one-fifth send 25 percent or some-more of their patients behind to a hospital, according to a Kaiser Health News research of information on Medicare’s Nursing Home Compare website. On a other finish of a spectrum, a fifth of homes with a lowest readmission rates lapse fewer than 17 percent of residents to a hospital.

Many health process experts contend that widespread shows how most alleviation is possible. But studious advocates fear a debate opposite hospitalizing nursing home patients might backfire, generally when Medicare starts joining readmission rates to a payments.

“We’re always disturbed a bad nursing homes are going to get a summary ‘Don’t send anyone to a hospital,’ ” pronounced Tony Chicotel, a staff profession during California Advocates for Nursing Home Reform, a nonprofit formed in San Francisco.

Richmond Pines, where Sandra Snipes stayed, has a aloft than normal rehospitalization rate of 25 percent, according to sovereign records. But a family’s lawyer, Kyle Nutt, pronounced a lawsuit claimed a nurses primarily resisted promulgation Snipes back, insisting she was “just drowsy.”

After Snipes was rehospitalized, her blood thinner was discontinued, her hip was reset, and she was liberated to a opposite nursing home, according to a family’s lawsuit. But her sanatorium trips were not over: When she showed signs of memorable infection, a second home sent her to nonetheless another hospital, a lawsuit alleged.

Ultimately, a lawsuit claimed that doctors private her prosthetic hip and some-more than a liter of putrescent blood clots and tissues. Nutt pronounced if Richmond Pines’ nurses had “caught a over-administration of a blood thinner right off a bat, we don’t consider any of this would have happened.”

Snipes returned home nonetheless was never means to travel again, according to a lawsuit. Her husband, William, cared for her until she died in 2015, her daughter, Clark, said.

“She didn’t wish to go behind into a nursing home,” Clark said. “She was terrified.”

Kaiser Health News is a nonprofit news use covering health issues. It is an editorially eccentric module of a Kaiser Family Foundation that is not dependent with Kaiser Permanente.

KHN’s coverage associated to aging and improving caring of comparison adults is upheld in partial byThe John A. Hartford Foundation. KHN’s coverage of end-of-life and critical illness issues is upheld in partial by the Gordon and Betty Moore Foundation.