You’re Gonna Need a Bigger Boat…

Good morning, ProviderNation.

Just when you thought it was safe to go back in the water. The Department of Health and Human Services’ Office of Inspector General is taking a new bite out of industry. A new report out this morning claims that skilled nursing facilities routinely flout rules on care plan and service requirements.

Based on a random sample of 245 nursing home stays during calendar year 2009, OIG claims that in:

  • 37 percent of stays, homes “did not meet care plan or service requirements;”
  • 26 percent of stays, homes “did not develop care plans that met requirements,” including “measurable objectives and detailed timeframes [sic];”
  • 19 percent of stays, homes “developed care plans that did not address one or more problem areas identified in the beneficiaries’ assessments;”
  • 15 percent of stays, homes “did not provide services in accordance with care plans;”
  • 31 percent of stays, homes “did not meet discharge planning requirements;”
  • 16 percent of stays, homes “did not have summaries of the beneficiaries’ stays or statuses at discharge;” and that in
  • 23 percent of stays, homes “did not have post-discharge plans of care.”

The report is full of stark tragedies and horrors, about wound care and medication management, and suggests—without exactly saying—that billions in Medicare funds are apparently at stake.

AHCA Senior Vice President Greg Crist says that OIG’s report is missing the Big Picture.

“The report fails to acknowledge broader, more universal quality indicators that are trending upwards, not backwards, that a lack of viable care plans would result in if folks were indeed suffering. Every one of our members is required to implement a care plan on the first day an individual enters the building,” he says. “Care plans change daily because a patients’ health needs change daily. If the care plan didn’t match 100 percent every day, OIG sees that as a violation. We see that as practicing medicine. Circumstances change, and our caregivers are adapting to meet new medical conditions. We’re more focused on health outcomes and have seen them improve for our patients.”


Filed under health care, Long term care, Post-acute care

6 responses to “You’re Gonna Need a Bigger Boat…

  1. lois

    What kind of experience in anything does the General Inspector have?

  2. dietitian in long term care

    Care plans do not contribute at all to care. They are just a peice of paper restating the obvious. Containing info that is aleady in the documentation, care guides and orders. They are used as tools for ciataions and not tools to provide for the resident. They should be done away with and focus should be put on the actual care of the residents and patients we treat.

  3. chris campbell

    Not to mention how old the data is. In this day of constant improvement in technology and software, over 3 year old data is not reflective of the current care plan status in ltc facilities.

  4. Kathleen Collins Pagels

    That is a right on, articulate reply to this report Greg Crist and AHCA.

  5. politically challenged

    Yep–could work on paper all day long and forget about the human being that nursing staff is supposed to be taking care of. Easy to look down on nursing facilities related to paperwork, especially if a facility misses one piece of a care plan (per regulation, this is a deficiency). For example, a facility in our region initiated booties to prevent heel ulcers on all residents who developed gastroenteritis and were too sick to get out of bed; surveyors entered the building and gave a deficiency for not care planning this. Too much paperwork and not enough common sense with bureaucracy and politics. Another “gotcha” moment with survey. Of course the nurse knew it was to be care planned, but when you have so many ill residents , what does a person focus on first–the resident or the paper? Better outcome with person-centered care than paperwork driven care.

  6. Joseph M. Casciani

    This is another way of saying that nearly 75% of care plans are on target and responsive to patient needs. That’s an impressive record.

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