It’s long been known that institutions are not the best place to be if you’re sick and, in fact, can make you sicker.
Take for example rehab hospitals. People who have sustained severe physical trauma or dysfunction of some kind typically go (or are sent) to a rehabilitation facility to start finding their way back to functional health. We tend not to think of them as dangerous places—quite the opposite. But recently, the investigative journalism organization ProPublica reported on a federal study that showed that rehab hospitals are the scene of an alarming number of incidents that endanger the health of their patients.
Errors and Other Harms
In the study of Medicare beneficiaries in rehab hospitals that was published by the Office of the Inspector General of the Department of Health and Human Services (DHHS) in June, it was found that “29 percent of patients in rehab facilities suffered a medication error, bedsore, infection or some other type of harm as a result of the care they received,” ProPublica reported. “Doctors who reviewed cases from a broad sampling of rehab facilities say that almost half of the 158 incidents they spotted among 417 patients were clearly or likely preventable.”
Nearly half of the adverse health incidents the study identified involved medication errors—for example, excessive bleeding from blood thinners or loss of consciousness from pain killers. Another 40 percent of the cases resulted from poor monitoring of patients, leading to falls, decubiti or infections.
More disturbing yet, a quarter of these incidents resulted in patients being moved to an acute-care hospital, adding some $7.7 million to the cost of care.
Dr. David Classen, who invented the tool used to measure the adverse health incidents studied, told ProPublica, “If the first rule of health care is ‘Do no harm,’ then we’re failing.”
The DHHS study echoes two previous ones the department undertook to investigate the level and cost of adverse outcomes for Medicare beneficiaries at other health care facilities: A 2010 study found that 13.5 percent of its subjects experienced adverse health events while being treated at hospitals; a study of nursing home residents conducted in 2014 showed that a third were exposed to harm.
That latter study of 653 randomly selected Medicare patients from more than 600 skilled nursing facilities for post-acute care also found that nearly 60 percent of these adverse incidents were preventable. “More than half of those harmed had to be readmitted to the hospital at an estimated cost of $208 million for the month studied—about 2 percent of Medicare’s total inpatient spending,” a ProPublica piece on the study reported.
“The doctors found that 22 percent of patients suffered events that caused lasting harm, and another 11 percent were temporarily harmed,” ProPublica reported. “In 1.5 percent of cases the patient died because of poor care, the report said. Though many who died had multiple illnesses, they had been expected to survive.”
Patient advocates cite the DHHS studies as evidence that these facilities need to improve their care, especially because demand for the care they provide is going up. Richard Mollot, executive director of New York’s Long Term Care Community Coalition, cited the fact that 40 percent of people over 65 will spend some time in a nursing home, either as a permanent resident or temporarily during post-acute care. ““They are dangerous, dangerous places,” he told ProPublica.
Advocates are Key
While improvement in care that will reduce the incidence of adverse events in these facilities is certainly desirable, more immediate remedies are possible for ICS members. Key to member safety during stays in health care facilities of any kind is a support network of family and friends to look out for your health. If you are able to, you can also play a role advocating for yourself. If you have concerns about the effects of medications on your health (or your loved one’s health), for example, don’t be afraid to speak up and ask questions.
And remember, if you or your loved one is an ICS member, do not hesitate to keep your care manager in the loop. In some cases, your care manager can advocate for you during your stay, and our Transitions Team can prepare for your safe discharge.