Medicare, the federal insurance program that provides payments to many skilled nursing homes, is now penalizing skilled care facilities when too many patients end up admitted to hospitals over and over again due to avoidable issues. Many people — of all ages — end up in skilled nursing care for a time after surgeries, accidents and illnesses.
However, Medicare typically only fully covers 20 days of a patient’s stay, after which other insurance programs like Medicaid gradually take over. Since the profit a facility makes on a patient decreases the longer the patient is there, facilities can be in a hurry to discharge patients in order to maximize the profit made on each bed.
Patients sent home before they are ready often end up right back in the hospital again. In 2016, 11 percent of skilled nursing patients ended up back in a hospital due to avoidable problems within 30 days of their discharge from a facility. That’s a huge signal that something is wrong with the way skilled nursing homes operate.
While the government’s action may be intended largely to prevent the unnecessary expense of those hospitalizations from being a drain on the system, the move has the effect of ringing a warning bell about patient neglect. Skilled nursing care facilities need to improve the care they take of their patients or suffer the financial consequences.
The new Medicare program isn’t all punitive. Facilities that perform the best will actually receive a bonus of up to 1.6 percent for each patient. Those that perform badly, however, can lose up to 2 percent of the payments they would have ordinarily received.
This action also encourages skilled care facilities to do more to assist patients with their care once they return home. Some facilities essentially leave patients to figure out their own ongoing care needs as soon as they are discharged without any assistance or coordination effort on the part of the facility. That needs to change.
Nursing home neglect and abuse is a serious problem. It can affect people of all ages who have undergone a health crisis, not just seniors. If a loved one has suffered harm due to inadequate or negligent treatment at a skilled nursing care facility, you may have the right to pursue justice through legal action.