IDPH has cited and fined Generations at Rock Island nursing home for a series of potentially catastrophic events which followed a reduction in the number of respiratory therapists on staff.
One of the unique features of the nursing home industry is that it is the only sector of the health-care industry that is explicitly for-profit. To be sure, many doctors would like to make a nice profit after paying themselves a good salary and taking care of the expenses of running a business and many hospitals are making bushels of money. However, these are people and institutions who view themselves as being health care providers first and foremost. This is often not the case with people who own and operate nursing homes – they view themselves as businessmen. And this often has a dramatic negative impact on the quality of care that nursing home residents receive.
Computing a profit is at its base a pretty simple exercise – you take your revenue, subtract your expenses, and that is your profit. Obviously, it is more complicated in practice, but that is the basic equation. Nursing homes get paid on a per-resident, per-day basis, with the rates varying depending on the payor and the level of care required. At a very simple level, the nursing home maximizes its revenues by filling as many beds as possible with as many truly sick people as possible. On the expense side, the largest single item of expense is staff which is why you so often see understaffing of nursing homes and the use of less qualified staff such as LPN’s rather than RN’s. This helps minimize the staffing costs and boosts the bottom line.
What the IDPH cited this nursing home for is an especially ugly example of what happens when the nursing home business model collides with patient care.
At this nursing home, there are residents who are on ventilators and who have tracheostomies. These are residents who have complex medical conditions and require specialized care and are the the kinds of residents for whom the nursing home receives a higher level of reimbursement. These residents were being treated by a staff of nine respiratory therapists who were in the facility on a 24/7 basis. One June 14, the nursing home cut the respiratory staff from nine to two – one Registered Respiratory Therapist and one Certified Respiratory Therapist. Respiratory care was reduced to 8 hours per day, Monday through Friday. For issues that arose over the weekend or outside of hours when the respiratory staff was in the building, the nursing staff would have to provide care for the residents.
The obvious problem with this is that the nursing staff was not up to the task. When interviewed by the state surveyor, the nurses, many of them LPN’s, freely admitted that they were not comfortable caring for residents with ventilators or tracheostomies and did not know what to do with the equipment. Many of them told the state surveyor that if there was a complication with a patient on a ventilator or tracheostomy, they would need to call 911. To remedy this lack of training, the nursing home had an in-service training called “Understanding Vent Troubleshooting” which was conducted by the one of the remaining respiratory therapists, and she told the surveyor that it was not an adequate substitute for the years of training and experience that trained respiratory therapists have. Of note only six nurses actually attended the in-service – and 5 were from the first shift which is when the respiratory staff is generally in the building and only one from the second and third shifts when there might not be a respiratory therapist in the building at all.
So – what impact did this have on patient care?
One ventilator dependent patient experienced a mucous plug during the night. For a patient on a ventilator, a mucous plug can be a fatal complication. She sounded the call light, but the nurse didn’t come for 40 minutes, so she lowered her bed, reached for the suctioning machine, and cleared the mucous plug herself. Another resident with a tracheostomy experienced heavy bleeding at the tracheostomy site. The likely cause of the bleeding was that the oxygen he received dried out the tissue because the mositurizing bottle was empty. This is another complication that has the potential to cause serious complications. And these are events that took place during the first two weeks after the reduction in the respiratory staff.
This may be one of times where it is clearest that the nursing home business model negatively impacts resident care. One of our core beliefs is that nursing homes are built to fail due to the business model they follow and that unnecessary accidental injuries and wrongful deaths of nursing home residents are the inevitable result. Order our FREE report, Built to Fail, to learn more about why. Our experienced Chicago nursing home lawyers are ready to help you understand what happened, why, and what your rights are. Contact us to get the help you need.
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