Patient Safety and Care Quality is a Concern for Many Home Health

Nursing Home Compare is a designated tool use as a referral source for the public who is trying to choose the best healthcare facility's provider. The Centers for Medicare and Medicaid Services CMS) has established this referral rating program to get an overall rating of homes health and hospitals’ performance and quality measures (CMS, 2017). The nursing home compare gives each facility a rating between one and five stars based on patients, residents or family members’ reviews. The Rating based on measures and performance includes Health Inspections, Staffing, and Quality of Resident Care (Medicare.gov, n.d.).

Problem Selection and Identification

CMS reports demonstrated that the category needing the most improvement is Health Inspection Rating based on its overall review and summary (CM, 2017). For every family member to feel at peace knowing that their loved ones are in good and safe hands, promoting patient safety in healthcare facilities is vital, and quality care a priority. Graph one shows the significant difference of health inspection rating between all three home health care agencies.

However, the lowest overall rating from all three nursing homes is from Adams Lane Care Center rating below an average of 2 out of 5. The care center had a low overall rating because it counts 1 star out of 5 in health inspection rating having a negative impact on its total score. According to Nursing Home Compare, Adams Lane Care Center has gotten nine complaints in the past three years that had resulted in 5 citations including three health citations (See Graph 2). There were also 3 actual harms with many affected residents. The agency had to pay a fine of $2,080 because of all the violations (CMS, 2017). All these complaints and citations have tremendously affected the health inspection rating bringing it down to a rate of 2 out 5 and making the overall rating and health inspection rating very poor.

Identification.

When looking at appendix one, some issues are encountered with health inspection and somehow staffing ratings. Studies revealed that nursing homes with the worst health inspection and staffing ratings rely more on Medicaid funding (Berlowitz, 2000). Berlowitz, (2000) mentioned that the existing disparity and gap are because many residents rely on Medicaid, but the home health care is not able to afford enough healthcare professional such as nurses or nurse assistants to care for all the residents (p.60). As a result, nursing home like Adams Lane Care Center experiences worst health inspection because of inadequate staff and poor care.

If having the possibility, many nursing homes will choose to get out of Medicare only because it is the lowest form of payment compare to private insurance and that is the reason why many residents have care and needs that are taking care of by Medicare (CMS, 2017). According to Vincent Moore (2000), most of the nursing homes that do not have a choice will settle for with negative comments while trying to get as many residents as possible by keeping their beds full and a low staffing level to care for them. It might be the case with Adams Care Lane Center that wants to keep up with the business by providing mediocre service for so many residents with a reduced staff.

History and Evolution of Problem

Patient safety and care quality is a concern for many home health, and those are factors that can significantly impact an organization’s review. Healthcare inspection is part of patient safety and involved other healthcare areas such as patient’s fall, accident hazard, food inspection, medication management and error, work environment, unplanned medical admission or readmission, mistreatment or neglect (CMS, 2017). Factors resulting in poor health inspection rating are based on residents or patients’ complaining that:

• Their personal information is not kept private and confidential

• They are mistreated or neglected

• There is no available assistance for grooming, during meal time, and personal hygiene.

• Management fails to report any act of abuse, mistreatment or neglect of patients or residents.

• There is a lack of policy on how to train or educate employee to identify, prevent, and report abuse or neglect of residents

• They are faced with medication error, inappropriate or unnecessary drugs admission

Problem Improvement Over Time

Interventions have been implemented to remedy the situation. There is a risk factor associated with medication error or administering inappropriate drugs and nurses must be aware and careful enough not to make such mistakes. An essential element to improve patient safety and lessen risk factors associated with quality care is to develop a better communication system with patients or residents. With the development of new technology, it will be much easier for healthcare management or providers to educate patients about their medications and provide them with the most accurate information. Also, pharmacist and management should be able to collaborate effectively to prevent any misunderstanding. Checking every patient’s medication before and during a visit will help to reduce the event of poor medication management.

Another emergent case for complaint in home health care is due to injury or accidents frequently reported by patients or residents. An annual report shows that there is up to 30 percent fall of older adults living in home health community with one out five requiring hospitalization (Corrigan and Donaldson, 2000). Among the older population, falls is considered the leading cause of injury-related death. However, the literature review reveals that there are interventions quality improvements programs such as education, follow-ups, valid and reliable instrument, multidisciplinary risk assessment with Morse scale, Physical therapy, Tinetti gait and balance evaluation in improving stability (Corrigan and Donaldson, 2000). All these intervention programs will help to prevent fall from happening and reduce the risk of injury or emergency care. According to Corrigan and Donaldson (2000), the implementation of fall prevention program will lower the rate of harm caused by falls or accidents from 2.58% to 1.72% within seven months with an increased report of falls by the staff. 

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