Map of life expectancy at birth from Global Education Project.

Monday, March 03, 2014

Granny on the ice floe?

There's been plenty of froo frah over people being injured by avoidable errors in hospitals -- back in 1999 the Institute of Medicine reported that at least 44,000 people, and maybe 98,000, died in hospitals every year from preventable errors. That was a famous report and we've been talking about it ever since.

Now the Medicare Inspector General says that more than 1,500 nursing home patients died from preventable errors in August, 2011, with much larger numbers being harmed. Also, this results in preventable hospital admissions costing Medicare $208 million per month.

Skilled nursing facilities vary a lot in quality, but I can tell you from my own experience that a) they are generally physician-free zones; and b) staff are often harried and resort to drugging people to keep them quiet and docile (called a "chemical straitjacket.") There are a few solvable problems here but one is that financial incentives can be perverse. The skilled nursing facility isn't penalized for avoidable hospitalizations. I don't think Medicare reimbursement rates are inadequate, but the same facilities have Medicaid patients (who have exhausted their Medicare long term care benefits and personal assets) for whom they are being paid less. And yes, some operators are unscrupulous.

Unfortunately, there aren't enough beds in the really good facilities and they won't even take Medicaid patients. This isn't my personal area of research but it's something we all need to take personally because we have parents or grandparents who end up in these places, or we will ourselves. We need to do better.

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