The article is part of the "Trust and Neglect" series by the Detroit Free Press which attempts to shed light on the challenges of the nursing home industry in Michigan. The first article in the series talks about the extent of the problem and adds names and stories to make the numbers real.
Many of the cases should disturb all of us:
- Staff tied a residents hands hands together with a garbage bag
- Respiratory therapist forgot to connect a patient to a ventilator; and also forgot to check his vitals
- Nurse fell asleep on the job allowing a patient to wander out of the facility
The reasons behind these mistakes are theoretically remediable:
- Nursing homes try to cover up errors
- Staff are overwhelmed
- Homes don't follow their own procedures
- Staff are not competent for the roles they are assigned
Some healthcare systems related issues that appear to be contributing:
- Bureaucratic rules that burden homes and their staff with too much paperwork
- Differences among inspectors about interpretation and application of rules
- Regulatory systems dependence on "fines, surveys, and lists" to censure chronically underperforming homes
We need more aggressive redesign of care processes, simplification of protocols, reduction of bureaucracy and paperwork. Perhaps this can lower costs of operations, and increase the amount of time that staff can spend on patient care.
Different business models have to emerge that are able to provide adequate, safe, quality care. Perhaps the "accountable care organization" model now being promulgated for Medicare patients - which rewards practitioners and facilities for reducing cost and improving quality - can provide a new financial model for facilities to improve their care processes.
A new regulatory framework also has to emerge to solve the "dilemma" posed by this report. In addition to fines, inspections, surveys, and lists, more aggressive action should be taken to ensure that staffing is appropriate to provide adequacy of care; or perhaps repeat offenders should be "mandated" to implement a structured, supervised "performance improvement system".