The Centers for Medicare and Medicaid Services proposed drastic changes last month. What could result would enforce stricter standards for facilities to comply with the organization’s requirements, but in looking at what nursing homes would have to do, a few significant issues pose major hurdles:

A Lack of Quality Care

Perhaps the biggest, the Department of Health and Human Services found that quality care continues to fall behind. Reports from the ‘00s, as nursing homes became more privatized, indicate facilities looking for more Medicaid reimbursement would simply fill their beds, keep staff low, and not consider patients’ needs.

Because of this approach, the Department of Health and Human Services had started setting guidelines regarding operational matters, including how nursing homes need to handle cases of abuse and fraud.

Stricter guidelines are already reflected in the CMS’s ratings. As of February 2015, evaluations include whether homes excessively use antipsychotic drugs and have sufficient staffing. In response, 15,000 homes receiving Medicaid and Medicare funding saw their ratings drop this year.

Patients Don’t Understand Their Rights

It has been a somewhat prevalent practice for homes to evict a disagreeable patient out. But “disagreeable” can be broad, ranging from family members requesting quality care to patients becoming violent.

The Nursing Home Reform Law spells out what homes can and cannot do, including when and under which conditions a home can evict patients. This document further covers how much influence a patient’s family can have, when physical and drug restraints may be used, and who needs to pay for a resident’s care. Families and patients are advised to understand this law to be fully be informed of their rights.

When and How Medicaid and Medicare Can be Used

Along the lines of who pays for a patient’s care, families often find themselves stuck with higher-than-expected bills. This scenario often occurs because families don’t understand how Medicaid and Medicare work for elder care. On a very general level:

  • Medicare provides limited reimbursement for care, but only if it’s tied to a short-term hospital stay (about 30 days maximum). Medicare does not reimburse custodial care.
  • Homes have long viewed patients using Medicaid for insurance as “less than.” As a result, facilities take such an approach in how they provide care. Patients and their families need to understand that, even though Medicaid may be used, they have the rights to the same services at the same quality as other patients.

High Turnover

Studies have shown that facilities with higher turnover rates often provide lower-quality care and result in patient behavioral issues. Furthermore, these homes appear to have more patients with pressure ulcers, pain, and urinary tract infections.

Homes looking to improve their reputation and give better care are recommended to focus on this area: That, if staff members are more likely to stay, patients remain in better condition.

When quality care isn’t provided or, worse, staff members are negligent and abusive, your family member may end up in a perilous situation. If you suspect malpractice, negligence, or abuse, bring your claim to Trantolo & Trantolo’s lawyers. Our law firm has a history of helping the elderly, and our team, in response, can examine your case.

Citations, “Ensuring nursing home quality is a top challenge for HHS in 2014, inspector general says”, “Twenty Common Nursing Home Problems and the Laws to Resolve Them”, “Quality problems in America’s nursing homes tied to turnover”

USA Today, “Nursing home quality scores drop in new federal ratings”