The demand for home health care businesses is growing – especially as baby boomers become part of the elderly population. A lot of people, regardless of age, prefer having services provided in their home if they’re required to receive ongoing care versus going to a nursing home. Taking care of people in their homes also presents risks just as it does in a medical facility. Even when providers are doing everything by the book, something such as a patient becoming injured or experiencing an allergic reaction can lead to a lawsuit. We’ve looked at five common allegations used in home healthcare litigation – and offer some suggestions for agencies to safeguard against having any or all of these allegations used against them.
#1 Medication and dosage errors – Most often medication errors happen as a result of something unintended such as miscommunication or a transcription error – so it’s always important to check and recheck the prescription for accuracy before administering the medication. Another type of medication error is when the patient is on a prescribed painkiller and mistakenly takes too much and then is in danger of dying from an overdose. The home health professional who finds a patient in this condition, should have available and use a drug called Narcan, an opioid antidote that can save a patient’s life if administered in time. A third medication risk occurs when a patient is on any type of blood thinner. Those patients are typically getting lab work done on a regular basis. If there is a change to the lab results and the doctor overseeing care is not notified by the home health worker, the patient could possibly be receiving unsafe doses of the blood thinner and may be at risk for bleeding to death. The best safeguard in this situation is to keep the primary care physician informed of all lab results so dosages can be adjusted if necessary.
#2 Failure to report abuse, fall or illness of the patient – Home health staff may not realize they have a responsibility to report potentially abusive situations. For example, if the patient says that another staff member was rude, disrespectful or maybe rough during a transfer or just downright mean – that needs to be reported as an allegation of abuse. Abuse is more than just being hit or kicked, it can be verbal assaults – being called a bad name or told that their smell is offensive – anything that it hurtful or demeaning to a patient could be considered abusive depending on the circumstances. In short, if the patient says it happened, it needs to be reported to a supervisor. In a case of serious accusation, such as sexual abuse, it would also need to be reported to appropriate regulatory agency. If a patient says they have fallen, that needs to be reported as well – even if the resident seems like they are OK. If it’s not reported to their supervisor, it may not get into the patient’s chart and it could be determined later that there was some harm done in the fall – for example, an internal injury or a fracture. Other issues to report are changes in condition or demeanor – a patient who usually communicates well and suddenly seems confused, for example, as it could be an indication that something is going on medically.
#3 Insufficient licensing and training of staff – Often a home health worker is hired and then quickly sent off to work in the field. What is important is that the employee is fully oriented and also given competency tests. They need to be tested to be sure they have the right skills to do what they are required to do safely in the patients’ homes – for example transferring a patient from a bed to a chair. Agencies can use tools like competency checklists. After a staff member had demonstrated proficiency in the necessary skills, the checklist can be placed in the employee’s file as documentation of the ability to do the required tasks. The testing for each competency should be done annually to make sure employees are able to do what is needed.
All home health employers should put a process in place to ensure that each employee’s license is verified not only at the time of hiring but also each year at the time that the license renews. The charge of working without a license can be used by a plaintiff attorney in a lawsuit if something happens and a patient is harmed by someone who should have a license but has not renewed it. It can also violate regulatory compliance laws – for example if a home health business is billing Medicare and there is a requirement that all staff be licensed – if it’s found that an employee was not licensed for some reason, the home health agency could be denied payment or fined for not meeting all requirements.
#4 Failure to follow primary physicians’ orders or treatment services – When home health care staff do not follow physicians’ orders, it’s usually not a case of deliberately defying the doctor’s instructions but rather it’s often unintended negligence. Perhaps they didn’t check for updates to the physician’s orders or treatment plan or, in some cases, the agency failed to communicate changes with the home health worker who is providing the care. The remedy for this is for the agency to create systems and processes – that everyone is trained to follow – for alerting staff when updates are made by the physician – whether it’s electronic medical records or paper documents that need to be flagged. Updates may also be communicated during handoff to another caregiver – to let them know things like a change in condition, a new order or change in prescribed medication.
#5 Insufficient background checks – A hiring home health agency may try to get references from previous employers but they are often told that its policy to not give references – this is usually to avoid getting sued for things like discrimination. However, the former employer will usually verify the dates of employment for the former staff person – and possibly indicate if the person is eligible for rehire. The hiring agency needs to make every attempt to get a reference from each of the previous three employers and then document the calls and whatever information that was given – including a no-reference policy. Conducting a criminal background check on each applicant is recommended and the employer should explain during the interview process which criminal offenses would prevent someone from being hired. To be safe, it’s also wise for the hiring agency to check the sex offender website , to be sure the applicant’s name does not show up there. If the candidate has a license, the employer should contact the licensing agency to verify that the applicant’s license is in good standing.
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