Risk Management in Nursing Homes
Keeping patients safe from injury is a high priority for nursing homes. Quite apart from the desire to sustain high levels of clinical care, the need to protect patients from injury is equally important from a financial point of view.
The potential adverse financial impact from the tarnishing of reputation in a competitive environment of privately owned nursing homes can be significant. With hip fractures representing two out of every five fall-related injuries in nursing homes,1 prevention of hip fractures is understandably a critical and ongoing challenge.
Given the limited success of fall-prevention programs,2 facilities are increasingly turning to fracture-prevention strategies that include the use of hip protectors.
Increased Costs
A recent comprehensive study found the average cost for inpatient care for hip fractures occurring in nursing homes to have risen to an average of around $29,000 per episode—not including the significant additional costs associated with skilled nursing care.1
Of particular importance to risk managers, to say nothing of owners, is the likelihood that changes in Medicare payments that already disallow reimbursement for fall-related injuries that occur in hospitals may be extended to nursing homes in the future as well. Given the overall economic challenges of managing long term care facilities, such a change is predicted to provide even greater incentive for reducing the incidence of fall related injuries, in particular hip fractures, in nursing homes.
Increased Medico-legal Risk
Fall-related injuries such as hip fractures also place nursing homes at significant and potentially expensive medico-legal risk, and not surprisingly account for a high proportion of healthcare litigation cases.
As a result, a growing number of long term care facilities consider hip protectors as the ultimate defense against hip fractures and thus an essential component of their care for residents at risk for hip fractures. Many even mandate this practice, requiring written legal waivers from residents who are considered at risk of hip fracture but refuse to wear hip protectors. Once more broadly established, national standards of care that incorporate the wearing of hip protectors are expected to play an even greater role in determining risk management policy development and implementation in all long term care facilities.
References
- Quigley P, Campbell R, Bulat T, Olney R, Buerhaus P, Needleman J. Incidence and cost of serious fall-related injuries in nursing homes. Clin Nurs Res. 2012;21:10–23.
- Oliver D, Hopper A, Seed P. Do hospital fall prevention programs work? A systematic review. J Am Geriatr Soc. 2000;48:1679–1689.
