Residents are the most reliable source of information for assessments and care-planning, and the interview items on the MDS 3.0 require their participation.
The RAI User Manual stresses that almost all residents, regardless of cognitive impairment, are able to answer simple questions about preferences, mood, and pain.
The manual lists a number of approaches to facilitate and increase the effectiveness of interviews.
A disastrous decrease in the number of U.S. long term care facilities is being fueled by several trends, says a recent Kaiser Healthcare report.
Many facilities were built during the 1960s, and often close because of their age and the trend away from long hallways with multi-resident rooms. The recession has reduced the number of investors willing to fund the construction of new facilities.
More people are unable to use private funds for long term care. The average cost of a private skilled nursing facility room was $77,745 in 2011, an increase of 30 percent since 2005.
Existing facilities are struggling because of cuts to Medicare and Medicaid. Long waiting lists for facility admission have been reported in Tallahassee and San Francisco.
The DHHS is fighting to stop Medicare and Medicaid fraud despite many obstacles, said Assistant Inspector General for Investigations Gary Cantrell in his December, 2011 testimony before the House of Representatives.
The OIG department employs 1,700 people, including 480 criminal investigators.
Mr. Cantrell said more Medicaid fraud cases involve home health services that any other area and include schemes such as “billing for equipment not provided or services not rendered, medical identity theft, false statements, bribery, and kickbacks.”
He said that Medicare fraud is easier to oversee than Medicaid fraud because there is no national-level timely data for Medicaid. The information is usually over 1 ½ years old by the time the OIG obtains it.
The OIG web site has resources to help providers prevent fraud and abuse, and also has a list of the 10 most wanted fraud fugitives with details about their schemes.
Preventing rehospitalizations has been identified as a crucial way to decrease unnecessary healthcare spending.
Falls are cited as the leading cause of injury and death for people 65 years and older and the most common cause of hospital admissions for trauma. Adverse medication events from polypharmacy and failure to take medications safely are also identified as common causes of preventable hospital admissions.
The 2010-2011 Home Health Quality Improvement report, funded by CMS, encourages the adoption of hospitalization risk assessments to target at risk patients.
Home Health Quality Improvement National Campaign
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Long Term Care Solutions
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