Recent ransomware attacks against healthcare facilities have exposed many institutions to serious HIPAA compliance issues—a situation which could have largely been avoided through some simple practical steps.
The single most important preventative measure is to ensure that all IT systems are always fully up-to-date.
Six residents’ rooms in a nursing home were infested with bed bugs and were treated by a pest exterminator and cleaned. This was not the first infestation the facility experienced. The facility was short-staffed in the housekeeping and laundry departments, causing less attention to be given in these areas, and the bed bugs were not identified immediately. One resident's family was thought to be the source of the infestation, and one other resident may also be affected; however, there are no signs of an infestation affecting the resident. The resident’s daughter is her guardian, and she will be informed that her brothers may not visit until it has been verified that their home is clean and certified as bed bug free. The facility is considering having a protective order issued against the two brothers, disallowing their visitation until they are treated. The facility is expected to be completely cleaned and then deep cleaned, with the visitation restriction lifted except for the resident’s family suspected of being the source. They will be required to visit only in the front lobby area where there is no upholstered furniture.
Published 11 July 2017 IU, Regenstrief study: Early home health worker visit lowers risk of hospital readmission
Reviewed by ShirleyAnn Janulewicz RN, BSN, PHN
According to a new Indiana University Center for Aging Research and Regenstrief Institute study, a visit by either a home health RN or physical therapist, within a week of an older adult’s (65+) discharge from a SNF appears to lower the risk of hospital readmission within 30 days by nearly half. Outpatient appointments with physicians, physician assistants or a nurse practitioner at the clinician’s office, which is more expensive and a burden to the patient and caregiver, did not have as strong an association with reduced risk of 30 day hospital readmission.
By: Linda Winston
An 83-year-old resident, identified as an elopement risk and with a WanderGuard bracelet in place, was able to get on the elevator at 10:30 in the evening and leave the locked unit unsupervised. A nurse in another unit returned her to the locked unit. The nurse on the locked unit did not report the resident’s elopement to anyone. Staff involved mistakenly felt that since the resident did not leave the building, it was not a significant event. However, if a resident is able to access any area inside or outside of the building they should not be in, it is considered elopement and a very serious situation.
By: Betty Frandsen, MHA, RN, NHA, CDONA, FACDONA, C-NE, IP-BC and R. Louise Lindsey, A.A., B.S., M.A., D.D.
Poor food, not enough staff are familiar complaints about nursing homes; however, the number one complaint according to the federal government is eviction. Technically, it is known as involuntary discharge, and in 2015 it brought in more than 9,000 complaints.
Two states, Maryland and Illinois, are investigating to discover the underlying causes of these complaints.
Maryland is suing one small chain of nursing homes for Medicaid fraud. It seems that more than half of all involuntary discharges in that state have come from this chain. According to Maryland’s attorney general, “The odds of getting evicted from one of this chain’s nursing homes is about 100 times that of other nursing homes in the state.”
The suit alleges that the company charged the state for services it didn’t deliver, specifically for discharge planning. Nursing homes are supposed to make sure a resident has a safe place to go, but these nursing homes sent residents with complex medical needs to homeless shelters or to unlicensed board-and-care facilities.
A surveyor observed a nurse had an abrasive tone that increased a resident’s agitation. The resident had requested that someone take him to the office in order to withdraw $40. The nurse told him that she was busy, but would take him in 10 minutes. In 8 minutes, the resident again requested to be assisted to the office, and the nurse used a forceful tone of voice in responding. The resident then raised his fist to the nurse, and a nurse aide intervened. The resident was then assisted to the office to withdraw his money. The same surveyor heard an unidentified aide state that “If he didn’t give his money away, he would not be broke.” The fact that this was reported by a surveyor and not a staff member indicates that the culture may allow for verbally abusive behaviors by the staff towards residents.
By ShirleyAnn Janulewicz RN, BSN, PHN
As a home health nurse, I believe that home health nurses should address the psychosocial needs of their patients, not just should see the patient, complete her assessment, perform the skills that were needed based on the plan of care, and then leave. All of those skills are necessary physical skills, but the patient is a whole person, and we need to treat the patient holistically, including addressing any routine psychosocial issues that the patient might be experiencing. A social worker would address a major psychological need and also assist with the application process for In Home Supportive Services, Meals on Wheels, and access transportation to assist them to get to appointments. However, at each and every visit, the home health nurse should address the routine psychosocial needs, such as verifying their status as important members of society despite their present illness, addressing their concerns that they were burdens to their caretakers, or just listening to them talk about their problems or concerns.
By: ShirleyAnn Janulewicz RN, BSN, PHN
When working in home health, personal safety should be first and foremost on your mind. Patients come from all socioeconomic backgrounds and live run-down homes in decaying sections of the city or in fancy homes in the affluent section of town. Home health workers must be totally focused and aware of their surroundings at all times.
It is a good idea for the home health agency to talk with the police servicing the areas its personnel will visit. The police know first-hand the safe and not-so-safe areas. They can identify those troubled areas that are safest to visit either with 2 coworkers, or possibly a police presence. They also should know what type of clothing is best to wear in the different areas. For example, in some areas a white lab coat is considered almost sacred, and a home health worker would be respected and watched out for. In other areas, the white-coat may represent an opportunity to obtain needles or medications that the worker may be carrying. Wearing a stethoscope around the neck signifies a health-care person, and again, an opportunity to obtain drugs or drug paraphernalia and medications. The key then is to dress nondescriptly in order to fit in with the neighborhood and not stand out.
By: Jeannine LeCompte
EpiPen manufacturer Mylan has been accused by the chairman of the Judiciary Committee, Senator Chuck Grassley, of deliberately overcharging Medicare and Medicaid by up to $1.27 billion through the use of incorrect classification of their auto-injector devices.
At the core of the scandal is the fact that, by law, pharmaceutical companies have to reimburse 13 percent of the total cost of a drug classed as “generic” when used by Medicaid or Medicare. Name brand drugs have to reimburse 23.1 percent of the total cost—and Mylan classified the EpiPen as generic for years even after being told repeatedly by the authorities that because it had no competitors, the product was not “generic.” EpiPens went from costing $57 in 2007 to costing around $600 in 2016, an indication of the profiteering which the product’s uniqueness could allow.
By: Jeannine LeCompte
An injury caused by a dropped ice cube in a Nebraska long-term care facility has highlighted the need for facilities to adhere to legal compliance guidelines. The incident occurred when a visitor—a granddaughter of one of the residents—slipped and fell in water located in the hall of the facility. It is believed that the water originated with a water pass during which ice cubes were dropped—and were not immediately cleaned up. This was not the first time there had been a water spillage of this nature in the facility, and the staff had failed on a number of previous occasions to address such lapses.
All contributions are made by members of our interdisciplinary team, which is made up of various healthcare specialists, licensed nursing administrators, directors of nursing, former Deportment of Health surveyors, and lawyers.