This month as I focus on medical malpractice, I uncovered a myriad of law offices throughout the nation trolling for home healthcare cases. Reasons given to contact these law firms for possible monetary remedy were: a) negligence by visiting nurses; b) medication errors such as failure to check for drug interactions or provide needed medication at the proper times; c) poor communication between the home healthcare nurse and doctors; d) poor human resources sent to a patient's home by training or overall competence; e) evidence of physical or verbal patient abuse; f) poor care coordination between acute and home healthcare providers; g) ignoring expressed concerns by the patient or family members; h) medical equipment failures; i) wheel chair injuries and transportation injuries; and j) overreliance on family members to perform the responsibilities of the home healthcare agency (Berg, 2015; DeLuca & Weizenbaum, 2016; The Cochran Firm, 2015).
Interestingly, one site focused specifically on nurse malpractice, describing it as the omission by the nurse to perform a task altogether or to perform it incorrectly. Examples were failure to take vital signs completely and at the proper time, failure to document observations, and making a mistake in administering food and water (Berg, 2015). The causes of action I would like to address from those listed above and fundamental to all the others are poor communication between the patient, family, and healthcare providers, and poor care coordination between acute and home healthcare providers.
I am reminded of the tremendous need for optimal communication and care coordination by experiencing the acute care to home healthcare transition with a family member. When communication and care continuity protocols are in place and utilized, care is optimal. When they are not, the family is left to problem solve. It has been a task of advocating for the patient, having to make the best choice from all bad choices, and screening out poor healthcare systems and individual providers to find the best solution for the patient. Three important resources were uncovered, which can be used by patients and family members seeking the best home care choice, providers trying to meet and promote quality-of-care initiatives, or legal experts attempting to prove or disprove legal causes of action when there are breakdowns.
1. The National Association of Home Care & Hospice (NAHC) offers invaluable questions to help identify qualified home healthcare providers. Highlights of these questions are:
How long has this provider been serving the community?
Does this provider supply literature explaining its services, eligibility requirements, fees, and funding sources?
How does this provider select and train its employees?
Are nurses or therapists required to evaluate the patient's home care needs? What does this entail? Are patients, physicians, and family members included?
Are patients and family members included in developing the plan of care and making care plan changes?
Is the patient's course of treatment documented, detailing the specific tasks to be carried out by each professional caregiver? Does the patient and his or her family receive a copy of this plan? Does this provider take time to educate family members on the care being administered to the patient?
Does this provider assign supervisors to oversee the quality of care patients are receiving in their homes? How often are visits made? How does the agency follow up on and resolve problems?
What are the financial procedures of this provider? Does the provider furnish written statements explaining all of the costs and payment plan options associated with home care?
What procedures does this provider have in place to handle emergencies? Are its caregivers available 24 hours a day, 7 days a week?
How does this provider ensure patient confidentiality? (NAHC, 2016).
NAHC further recommends asking each home care provider for a list of references from multiple consumers or stakeholders who are most familiar with that provider's quality of service.
2. Ellenbecker et al. (2007) remind us of the daunting task of delivering home care. Services provided include nursing care; physical, occupational, and speech language therapy; and social services. There is a huge scope of practice to manage between healthcare providers as well as between healthcare providers and the patient. Home healthcare goals are: to enhance the patient's quality of life by improving their function to perform activities of daily living, avoiding hospitalizations, and living with greater quality and independence. The Centers for Disease Control and Prevention (2012) reported over 12,200 home healthcare agencies and 4.7 million patients are treated annually. Ellenbecker et al. recognized key problem areas in meeting expectations: medication management, nurse work environment, wound and pressure ulcer management, falls, and unplanned hospitalizations. Their work includes quality measures to quantify each problem with summary result tables.
3. Mitchell et al. (2012) round out this resource list with their work on team-based healthcare. They astutely recognize that healthcare has not always been described as a team sport. The complexity of the healthcare industry and patient needs have required healthcare providers and systems to work together. Values of team-based care are: effective communication within the team, performing roles and responsibilities with discipline, thinking creatively, maintaining humility, and seeking continuous improvement. Team-based care principles center on mutual trust of each other and having measurable processes and outcomes for the goals to be achieved. Care coordination ensures patient needs and preferences for care are understood and shared between providers and healthcare settings, including home care. Waste, bad decisions and practices, and conflicting care plans are avoided with good communication and care coordination.
Legal advocacy always remains an option when a breach in care happens. However, home healthcare patients and families rely on the healthcare industry to first do no harm. The Institute of Medicine discussion paper Communicating with Patients on Health Care Evidence reports that 92% of people agree that healthcare providers should work as a team to coordinate care and share health information. For patients with chronic conditions, 97% agreed their care should be coordinated. These findings strongly support the conclusion that "not only should care be coordinated to increase quality, but that patients already expect to receive coordinated care." (Mitchell et al., 2012, p. 23)
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