Cutting Reimbursements May Increase Boston Nursing Home Injuries

In late October 2011, Massachusetts Gov. Deval Patrick signed a supplemental $169 million state budget. To the surprise of many, the only item Gov. Patrick vetoed was $6 million dedicated to the state’s 10-year-old “bed hold” program. After significant public pressure, the governor changed course and authorized the funding for the program to continue for one more year.

Massachusetts’ “bed hold” program pays nursing homes to hold a patient’s bed for up to 10 days while the patient is away for a hospital stay or visiting family. The state law goes beyond the federal law that requires nursing homes to readmit patients after brief periods of leave and provide them the first bed available in a shared room. Unlike the Massachusetts program, the federal law does not guarantee the patient the same bed or even the same room.

No matter how they are structured, bed hold programs aim to ensure continuity of care. Without such continuity, the risk of nursing home negligence in Massachusetts rises.

Statistics indicate that approximately 4,000 Massachusetts nursing home beds were empty on any given day. The governor’s original veto reflected the view that there were enough beds to go around and holding them was unnecessary. However, those empty beds are not spread out equally across the state and some nursing homes are in higher demand than others.

More importantly, constantly changing beds, rooms and even nursing homes can be extremely distressing and confusing for elderly patients, particularly for those suffering from Alzheimer’s disease or dementia. The quality of health care can also be negatively impacted, as new staff must learn an individual’s medical history and unique needs.

In some cases, doctors’ orders and medication prescriptions have been lost in the transition, resulting in both mental and physical injuries to patients. Additional physical injuries can occur from requiring an ailing patient to navigate completely new surroundings.

Under the new (compromised) plan, in place through the end of June 2012, the state will only pay to hold beds in nursing homes that are nearly full. The idea is that money will only be paid out when there is a serious likelihood that a patient’s bed will be given away. While the plan may look good on paper, it does not protect all patients from the risk of being shuffled around from nursing home to nursing home should they need to temporarily stay in the hospital.

While the compromised program sounds more fiscally efficient, whether it actually protects its target group remains to be seen.