As part of the larger health care reform in our country, President Obama signed into law on March 23, 2010 the Patient Protection and Affordable Care Act (PPACA) which contains provisions for Nursing Home Transparency and Improvement. In a series of posts, I will discuss some of the provisions which affect nursing home care.
This is part 2 in a 5 part series
Part 2 - Quality Assurance and Compliance Programs
The PPACA [at Title VI, Subt. B, 6102(b)92)(B) ] requires nursing homes to establish policies and procedures to prevent and detect civil, administrative and criminal violations as well as promote quality of care. This provision first requires the Department of Health and Human Services to establish standards for quality assurance and performance standards by December 31, 2011. Then, within 1 year of those regulations, nursing homes must submit a plan for meeting those standards. These standards will provide yet another set of "safety rules" that nursing homes are required to adhere to. Of course, a failure to meet those standards can give rise tort liability.
What effect will this have? It's hard to say.
Nursing home operators are already required to provide training to staff to recognize and report elder abuse. Unfortunately, the typical training regarding elder abuse relates to physical assaults (slapping, hitting, rough handling, and worse). But more typically, "elder abuse" comes in the form of neglect.
If a resident in a nursing home is at particular risk for harm or injury (say at risk for falling or at risk for bedsores), and the nursing home either fails to assess that risk or fails to takes steps to minimize the harm flowing from the risk), either because they are understaffed and don't have time or because implementing those prevention measures would be too costly or too time consuming, that qualifies as "neglect" under the California Elder Abuse Act and should give risk to liability. It also violates a resident's rights to have their needs identified, assessed, re-assessed. As well, a resident's individualized care needs must be identified so that care for those needs can be planned, implemented and periodically re-evaluated.
The failure to care plan effectively can lead to disastrous consequences because the "care plan" is the resource ever-changing nursing staff looks to know what particular care a resident needs. Not every octogenarian in a nursing home bed requires the same care. Nursing home staff rotates every 8-12 hours. Turnover in the course of a year is staggering, and typically well exceeds 100% for certified nursing aides. The care plan is a recipe. This patient requires more frequent toileting, that patient is incontinent. This patient wanders and must be monitored closely. That patient is bedridden and must be turned and repositioned every hour to prevent bedsores.
Hopefully, the regulations will include further provisions to promote patient safety. Under the current state of safety rules, it's pretty easy to determine what nursing homes are supposed to do. The question is, what consequence results when the nursing home fails to do what they are legally required to do?
See Part 3 - Staffing
