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REHAB SHOULDN'T HARM YOU

‘Problem Care’ Harms Almost One-Third of Rehab Hospital Patients Many patients sent to rehab facilities to recover from medical crises or procedures sometimes suffer additional harm from the care itself, a government study concludes. This story was co-published with NPR's Shots blog. Patients may go to rehabilitation hospitals to recover from a stroke, injury, or recent surgery. But sometimes the care makes things worse. In a government report published Thursday, 29 percent of patients in rehab facilities suffered a medication error, bedsore, infection or some other type of harm as a result of the care they received. Doctors who reviewed cases from a broad sampling of rehab facilities say that almost half of the 158 incidents they spotted among 417 patients were clearly or likely preventable. “This is the latest study over a long time period now that says we still have high rates of harm,” says Dr. David Classen, an infectious disease specialist at the University of Utah School of Medicine who developed the analytic tool used in the report to identify the harm to patients. “We’re fooling ourselves if we say we have made improvement,” Classen says. “If the first rule of health care is ‘Do no harm,’ then we’re failing.” The oversight study, from the office of the inspector general of the U.S. Department of Health and Human Services, focused on rehabilitation facilities that were not associated with hospitals. Rehab facilities generally require that patients be able to undergo at least three hours of physical and occupational therapy per day, five days a week. Patients at these facilities are presumed to be healthier than patients in a more typical hospital or a nursing home. Still, the findings echoed those of previous studies that found that more than a quarter of patients in hospitals and a third in skilled nursing facilities suffered harm related to their care. “It’s important to acknowledge that harm can occur in any type of inpatient setting,” says Amy Ashcraft, a team leader for the rehabilitation hospital study. “This is one of the settings that’s most likely to be underestimated in terms of what type of harm can occur.” For the purposes of the study, doctors and nurses identified harm by reviewing the medical records of 417 randomly selected Medicare patients who stayed in U.S. rehabilitation facilities in March 2012. The events they identified varied in severity, ranging from a temporary injury to something that required a longer stay at the facility or that led to permanent disability or death. Almost a quarter of the harmed patients had to be admitted to an acute care hospital, at a cost of about $7.7 million for the month analyzed, the study shows. The physicians who reviewed the cases for the OIG say substandard treatment, inadequate monitoring, and failure to provide needed care caused most of the harm. Almost half the cases, 46 percent, were related to medication errors, and included bleeding from gastric ulcers due to blood thinners and a loss of consciousness linked to narcotic painkillers. That high number indicates there’s lots of room for improvement, says Dr. Eric Thomas, director of the UT Houston-Memorial Hermann Center for Healthcare Quality and Safety. “We know a lot about preventing medication errors,” Thomas says. Another 40 percent of the cases in which patients were harmed were traced to lapses in routine monitoring that led to bedsores, constipation or falls. These problems almost never contributed to a patient’s death, but could mean extra days or weeks of recovery, a loss of independence or permanent disability, says Lisa McGiffert, director of the Consumers Union Safe Patient Project. “It is a domino effect for any person who has had an adverse event,” says McGiffert, who was not involved in the study. The inspector general is recommending that Medicare and the Agency for Healthcare Research and Quality work together to reduce harm to patients by creating a list of adverse events that occur in rehab hospitals. In their responses to the report, the agencies have pledged to follow that suggestion. Officials from the American Medical Rehabilitation Providers Association, the trade group that represents rehab facilities, say they have not yet seen the report and decline to comment for now. Update, July 25, 2016: The American Medical Rehabilitation Providers Associationissued a statement late Friday, saying they welcome any study that shows opportunities to improve care. The rehab industry has made improvements to reduce medical errors since 2012, the time frame studied by the OIG, the statement said, and remains dedicated to providing high quality care. But the facilities still face pressure to speed up the pace of care and “press patients into less expensive settings,” which is counter to the “need to take time to do things right the first time,” the statement said..

ELDER MALTREATMENT

According to the U.S. Centers for Disease Control and Prevention (CDC), elder physical abuse is a form of elder maltreatment. Elder maltreatment is any form of neglect or abuse which occurs to people that are 60 years of age or older. Elder physical abuse may come from a caregiver, an acquaintance, a nurse, doctor, family member, or any other person the elderly patient has contact with. However, according to the U.S. National Committee for the Prevention of Elder Abuse (NCPEA), elder physical abuse perpetrators are most likely to be unmarried, unemployed, and to live with the elderly patient. Types of Elder Physical Abuse Forms of elderly physical abuse may include, but are not limited to, the following: – Scratches – Bites – Burns – Being pushed, hit, shoved, or slapped – Threats or assault with a weapon, including guns, knives, and other objects – Inappropriate use of restraint

FINANCIAL ELDER ABUSE IS ON THE RISE

Financial elder abuse — broadly defined as the illegal or improper use of the funds, property, or assets of people 60 and older by family, friends, neighbors, and strangers — is rising fast. Estimates of the crime’s frequency vary. A 2010 survey of seniors by the nonprofit Investor Protection Trust projected that 1 in 5 seniors had been taken advantage of financially. A study last year in the Journal of General Internal Medicine found that 4.7 percent of Americans — about 1 in 20 — reported that they had been financially exploited in their later years. The study provided perspective: If a new disease struck that same percentage of older Americans, researchers wrote, “a public health crisis would likely be declared.” The Federal Trade Commission says that fraud complaints to its offices by individuals 60 and older rose at least 47 percent between 2012 and 2014. Seniors are the predominant victims of impostor schemes, in which criminals pose as government officials or other authority figures and claim that money is owed. We also are hit hard by gambits involving prizes, sweepstakes, and gifts. Older people’s vulnerabilities — including isolation, loneliness, generally trusting natures, relative wealth, and in some cases declining mental capabilities — make us ideal quarry for con artists. Even older people whose cognition is intact can be swayed if they’re stressed or depressed, or recently have lost a loved one. The amount lost to swindlers, whether they are strangers or even relatives, is huge, with estimates ranging from almost $3 billion to more than $30 billion annually. And as baby boomers age, the pool of potential victims will expand, with assets ripe for the pickpocketing.

HEALTHCARE SPENDING WILL BE $2.6 TRILLION LESS THAN ESTIMATED

Health spending in the U.S. appears to be dramatically lower than analysts had projected immediately after passage of the Affordable Care Act, a new analysis suggests. The new projections indicate that the U.S. will spend approximately $2.6 trillion less on health care in the five-year period ending in 2019 than estimated, despite a brief spike in health spending in 2014, the authors say. "Obviously the people [who made the initial estimates] were wrong by 2.6 trillion dollars," Gary Claxton, vice-president of the Kaiser Family Foundation, a non-profit health policy institute, said Wednesday. "The interesting thing is that, over the last couple of years, we managed to greatly increase the number of people with access to care and increase their benefits and still maintain low rates of growth," Claxton says. "The question is how long these low growth rates will go on." Health spending slowed in Medicare, Medicaid and private health insurance. Analysts at the Centers for Medicare and Medicaid have predicted that spending will be $455 billion lower than expected. Medicaid spending, they now say, will be $1.05 billion lower than predicted. Even spending for private health insurance was $664 billion lower than the government's forecast.