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In every calendar year, roughly 25% of all the patients in a nursing home are transferred to a hospital or emergency room. There have been recent concerns within the healthcare community that transfer rates are higher than what they should be. A recently published study looks at the frequency of hospitalizations in New York nursing homes and what impact education programs can have on preventing transfers.

In the world of long term care, hospitalizations are not generally beneficial to the patient. Such events not only indicate a deterioration in patient health, but the actual act of transferring can put great strain on a person’s body, mind, and health: transportation, change in environment and people, miscommunications about treatment and care plans, etc. Communication between nursing facilities and emergency personnel/hospital staff is an area where much can slip through the cracks, resulting in worse care for the patient. An article that was published last year delves into the issues surrounding the lack of thorough communication involved in hospitalizations. The authors recommended that a more comprehensive documentation system be put into place and that verbal communication, to augment and explain written forms, be mandatory. In the present state of affairs, much information is lost between facilities as people fail to completely fill out transfer forms or are unable to understand the notes of the other facility. In such cases it is the patient’s quality of care that suffers and the already stressful process of transferring from facility to facility is made worse.

Considering the toll hospitalizations can take on the health of those in long-term sub-acute care, it is important for skilled nursing facilities to attempt to reduce any unnecessary or preventable transfers. The recent study of New York nursing homes reported that in using an education and training system, they were able to observably lower the rate of hospitalization. The program used is called INTERACT, “Interventions to Reduce Acute Care Transfers”. The main principles of this system are educating nursing home staff in early detection of problems and how to communicate and handle these issues in a timely fashion, before they become severe enough to need transfer to an emergency facility.

The lynchpin on this program is the education of employees in how to recognize problem symptoms and the correct responses to any such problems. The efficacy of the INTERACT program, which has been through multiple successful trials, speaks to the fact that good training systems for staff are not currently in place. The failure of a nursing home to adequately train staff violates the patient’s right to be cared for by knowledgeable and qualified care-givers, set down in Health and Safety Codes. Factors that can commonly contribute to failure to provide proper training to employees are understaffing and fiscal meanness.

In the situation discussed in the referenced study, untrained staff can lead to increased hospitalizations and miscommunications between facilities, which can have a great negative impact on the patient. And there are many other harms that can be inflicted upon residents in understaffed nursing homes. Conditions such as pressure sores are preventable with enough care and attention, but can become severe and very painful if a patient is not well-looked after or if the proper preventative measures are not carried out. Infection control is also greatly affected by staff numbers and education. Studies have shown that a great number of nursing home staff are not educated in basic infection prevention techniques, such as proper hand washing and sterilization. Lack of training in this area, along with low staffing levels, has been correlated with higher rates of preventable infections, such as scabies and methicillin-resistant Staphylococcus aureus (MRSA).

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The Journal of the American Medical Directors Association (JAMDA) recently published an article titled, “Factors Associated with Physician and Nurse Practitioner Pressure Ulcer Staging Practices in Rehabilitative and Long-Term Care” that studied patterns of assessment, staging, and documentation practices concerning pressure ulcer wounds in skilled nursing facilities.

The study investigated patients within two different facilities: a chronic hospital and a nursing home facility that each provided 140 beds, 100 of which were long term care and 40 of which were rehabilitative. They examined data provided by two different sources: a provider and a nurse from the chronic hospital and the nursing home. Both facilities established weekly wound rounds and created a wound log in order to keep track of patients with developing pressure ulcers. Of the 57 subjects involved with the study, the health care provider only documented pressure ulcer stages for 30. In comparison, the nurse was able to document a pressure ulcer stage for 52 of the 57 subjects.

Researchers found that there is noticeable confusion in the determination of pressure ulcer stages between providers and nurses, and that there is a lack of a standardized means to clearly categorize the stage of a pressure ulcer. These inconsistencies in the staging of pressure ulcers can be fatal, as applying improper treatments could result in further injury or death of the patient. For example, if an uneducated nurse treated a Stage 3 pressure ulcer as a Stage 1, the treatment would be nowhere near effective enough to heal the wound, and could lead to the patient’s death. Therefore, it is very important that the medical providers and nurses are able to accurately assess the stage of pressure ulcers.

However, even when the staging of a patient’s pressure ulcer is consistent among different staff members of the nursing home, the study notes that “documentation practices are of particular importance as discrepancies between nursing documentation…may compromise patient care.” For instance, if one nurse fails to document that a patient is beginning to develop a pressure ulcer, the nurse working the next shift may be unaware of this new condition and fail to provide the patient with the proper care. Consequently, the pressure ulcer will be allowed to become more severe. Ultimately, the nursing home staff is responsible for maintaining organized records of their patients’ health.

It becomes apparent that a nursing home’s staff plays an instrumental role in the treatment and prevention of pressure ulcers. Unfortunately, however, pressure ulcers are often caused by a facilities’ lack of staff or education. You should also be cautious of the quality of your loved one’s nursing staff. Even if it appears that the facility is fully staffed, many nursing homes often cut costs by hiring less licensed nurses and more nursing assistants, thus sacrificing the qualifications needed to properly care for patients. Studies have actually linked lower levels of direct care from Registered Nurses to increased incidents of pressure ulcers.

The providers and nurses within JAMDA’s study display an alarming lack of knowledge concerning pressure ulcers. Providers and nurses alike should be able to understand the importance of clearly documenting pressure ulcers. Either ignoring or incorrectly assessing the stage of a pressure ulcer violates the Patients’ Bill of Rights, which states that skilled nursing facilities are obligated to ensure that patients are free from developing pressure sores. Moreover, if the patient does develop a pressure sore, the patient has a right to receive the appropriate treatments and care.

It is much easier to prevent a pressure ulcer from forming in the first place, as treating an already developed pressure ulcer can be problematic. There are many preventative measures that can be taken, ranging from movement and position changes to a nutritious, well balanced diet. However, for these preventative measures to be effectively carried out, one of the most important factors in preventing pressure ulcers is that an adequate nursing staff level should be provided by the health facility to their patients.

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A recent study published in the Journal of Hospital Infection looks at the transmission of bacteria in long term care facilities. The researchers reported the results of their experiment in “Effect of an infection control programme on bacterial contamination of enteral feed in nursing homes”. The study measured the spread of methicillin-resistant Staphylococcus aureus (MRSA), a prevalent healthcare associated infection, between patients with enteral feeding systems and nursing staff.

Enteral feeding is used on nursing home and hospital patients who, for whatever reason, cannot feed themselves. A tubing line is threaded down the esophagus to the stomach or inserted directly into through the stomach wall. These patients are given a liquid milk based diet. Because the method of feeding delivers food directly into the body, proper hygiene when dealing with the feed or equipment is very important as such patients are more susceptible to infection. This study found that contamination of enteral feed and equipment was quite prevalent in nursing homes. The most frequent vector of spread was the hands of nursing home staff, which had not been adequately washed and decontaminated as they moved from patient to patient.

The researchers found that establishing an infection control procedure (ICP) in the home greatly reduced contamination and infection. The ICP consisted of educating the staff about enteral feeding and how to clean equipment, but most important was teaching about proper hand-washing and hygiene techniques. The simple act of making sure that employee hands were cleaned between patient visits had a great impact on reducing infection threats.

As part of the Patients’ Bill of Rights,every nursing home resident is entitled to reside in a hygienic environment, without the threat of constant infection or injury. It is the responsibility of the home to provide this. As this study shows, just the simple act of hand washing can have a huge impact on infection spread. Nursing homes need to spend the time to educate their employees in infection control procedures and other general safety measures.

Beyond the lack of knowledge of infection control measures, many nursing homes do not employ enough staff to fully carry them out. When nursing homes are understaffed, those nurses who are caring for all of the patients are more hurried and stressed, which can lead to lapses in judgment, lax adherence to infection control measures and other healthcare guidelines, and burnout syndrome. This directly imparts a negative impact upon nursing home residents. Laxity in infection control increases infection rates in homes, which can at minimum cause the patient a great deal of discomfort and at worse result in their premature death. The MRSA contaminations observed in the study discussed are correlated with at least a 2.5 fold increase in mortality.

Prevention of falls and pressure sores are also within a nursing home’s purview. Training and time on the part of staff members is integral in avoiding such injuries. And at times lack of staffing resources can spur employees to use drastic measures to cope with overwork, such as the excessive application of restraining devices in the stead of direct care, supervision, and assistance. Such acts can not only increase the patient’s risk for further injury, but also constitute an infringement upon every nursing home patient’s rights.

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The job of prescribing medications requires balance. The goal must be to improve the health of the patient as much as possible while minimizing risks, taking into account any negative side-effects or quality of life issues. Such considerations are especially important for elder care in nursing homes, as the residents generally have more delicate systems. The US Food and Drug Administration (FDA) puts out guidelines for best practice prescribing based on scientific studies about efficacy and side-effects. And yet a poor prescribing policy can be found in most nursing homes. A study published in The American Journal of Geriatric Pharmacotherapy looked at this problem specifically through the lens of antipsychotic medications.

Antipsychotic medications are developed to treat patients with psychotic episodes, such as can been seen in bipolar disorder and schizophrenia. These medications include haloperidol and clozapine and generally act as sedatives. In nursing homes, use is usually off-label, frequently to subdue patients with dementia-related agitation. Off-label use is not supported by the FDA. Up to 80% of all antipsychotic use in nursing homes is off-label, for behavioral management. But with off-label use there are no FDA guidelines regulating prescription. Less testing for efficacy and side-effects is carried out for off-label usage. Such prescribing can be risky, even with the “black box” labels that the FDA puts on to warn nursing home staff of the drugs’ dangers.

Hundreds of thousands of nursing home residents are currently being prescribed antipsychotic medications. Most of this use is non-recommended. The issue of nursing home overuse of antipsychotics is important as the clinical studies conducted for off-label use of these medications report that there are little to no medical benefits, while there are many side-effects including strokes and increased morbidity and mortality. Such use is generally just for the purpose of subduing or restraining patients, to make caring for them an easier task. But the use of any type of restraint, physical or chemical, that is not for the direct medical benefit of the patient is prohibited by federal and state law.

Off-label use of antipsychotic drugs for non-medical purposes is commonly found in conjunction with understaffing in nursing homes. The belief is that more subdued and compliant patients mean that fewer nurses can perform the same care tasks in less time. But this assumption is not fact based, and is a violation of patient rights. Studies have shown that nursing homes that do not use any type of restraint with such patients do not actually need more staff to complete daily assistance and care activities. Nursing homes seem to act without much regard for scientific evidence in their use of antipsychotic drugs. Even with federal regulation of antipsychotic medication use, with sanctions for improper prescription, many facilities still refuse to change their policies. There is a financial motivation for such drug use, as Medicaid pays out billions each year for such prescriptions. And unfortunately, nursing homes placing finances ahead of patient welfare and health is not an unknown phenomenon.

Such actions are not only immoral, they are illegal. Both state and federal legislation speak to the quality of care and treatment that nursing homes must provide. This includes a fully staffed home with a hygienic and safe environment. But if a nursing home fails to meet these legally proscribed standards, under California Health and Safety Code 1430(b), you are allowed to sue for damages to health and wellbeing.

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The Journal of the American Medical Director’s Association has just published a literature survey looking at the overuse of antibiotics and spread of resistant bacteria strains in long-term healthcare institutions. The authors have sifted through 156 scholarly reports on the subject to come up with a synthesized statement on long-term care and antibiotic resistance. They have also focused on prevention measures, both against the creation of new resistant strains and the spread of infections throughout facilities. These observations are particularly relevant to skilled nursing facilities as the elderly are at an increased risk for severe infections due to more compromised immune systems and other care factors.

The use of antibiotics in long-term care has a very high prevalence. On average, 47 to 79% of all patients are one some kind of antibiotic, for a wide array of health reasons. While these drugs are a vital tool in healthcare, not all use is warranted or correct. The overuse and misuse of antibiotics can result in bacterial super-strains, that are resistant to all or most of known antibiotics and generally have a higher rate of morbidity and mortality. Perhaps the most well-known of these strains is methicillin-resistant Staphylococcus aureus, or as it is more commonly known: MRSA. Other resistant infections include strains of pneumonia, strep, meningitis, and many cases of sepsis. The numbers of resistant infections have gone up greatly over the last decade. In order to break this trend, training about the misuse of antibiotics has to be stressed, especially in places like nursing homes where prescription rates are very high. The study also identifies the failure to implement infection control procedures as an issue in nursing facilities, putting patients at risk. Only 38.1% of all nursing homes employ an infection control officer.

The misuse of medication can be a problem in skilled nursing facilities. Many institutions do not employ the necessary numbers of nursing staff to see to all of the needs of each resident individually. In such long-term care facilities many patients require assistance in normal function and activities. But instead of devoting the staffing hours necessary to supervise the patients to prevent falls and accidents, some places will instead prescribe antipsychotic drugs and tranquilizers to subdue and restrain them. Off-label prescribing to chemically control patients is frequently employed in conjunction with excessive use of physical restraints. The use of medications as restraints is not only dangerous as many of the drugs can have very harmful side-effects, but it is also a direct violation of patients’ rights.

By law, nursing care facilities are required to provide adequate staff to supervise and assist in daily activities for those patients that need it, and the use of medications instead of direct care contact is abuse. California Health and Safety Code section 1430(b) allows any patient that has been subject to injury and abuse to sue the offending facility for damages. Other abuses that can prompt a 1430(b) case include dehydration, malnutrition, pressure ulcers, and the improper treatment of incontinence issues.

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A recently published study examines levels of burnout in healthcare workers. Via interview and survey, the researchers looked to discover what percentage of workers suffer, what are the contributing factors that make staff more susceptible, and what types of facilities are most conducive to burnout. The study concluded that burnout is higher in long-term care facilities, especially nursing homes.

On average, 18% of all those involved in healthcare suffer from burnout. Burnout syndrome is characterized by emotional and physical exhaustion, depersonalization with respect to patients, and a low perception of job worth. The study also measured the average levels of each symptom, observing a 33% incident of exhaustion and that 36% of healthcare providers suffer from depersonalization. These values are higher in nurses and assistants, as the amount of time spent in direct contact with patients corresponds with the likeliness of burnout. Because they employ mainly nurses, skilled nursing facilities have an even higher risk than other healthcare center.

Burnout not only has a detrimental effect on employees, but can directly impact the quality of care given to residents. Staff suffering from burnout are much more likely to be irritable, anxious, and moody, resulting in fraught relations with patients and their families. They are also less productive and time efficient. As a result, other staff members are put under more stress to pick up the workload. The quality of care that the patients receive for those with burnout syndrome can also significantly decrease.

Burnout is a very significant issue for nursing homes as it is harmful to both employees and patients. Facilities should take precautions to prevent burnout from happening. Studies indicate that overwork and stress are major factors in burnout, such as would be experienced in an understaffed nursing home. Adequate preparation and job specific training can also help staff avoid burnout. For this reason, and others, it is very important that enough nursing staff are employed to fully take care of all residents. Besides burnout, understaffing can harm patients in other ways, including infection outbreaks, increased fall risks, and even wrongful death.

Perhaps one of the most common injuries brought about by understaffing is the development of pressure ulcers. Pressure sores occur when a bedridden, or largely immobile, patient spends too long in one position and pressure upon tender areas of skin causes the damage and death of issue. Bedsores can become so severe as to destroy the surrounding muscle and even expose bone. Pressure ulcers are preventable, so it is a travesty when nursing home residents are forced to go through long periods of suffering due to them. In some cases, the severity of decubitus ulcers can even lead to death. When there is adequate staff in a nursing home to properly care for their residents, pressure sores can be prevented by periodically repositioning the patient so as to relieve pressure on sensitive areas and keeping up with nutrition, hydration and activities to maintain skin health. These prevention techniques are very effective and relatively easy to do, as long as the nursing home employs enough staff to fully care for their patients, and not violate their right to a good quality of life.

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Methicillin-resistant Staphylococcus aureus (MRSA) is an infection that is commonly contracted by residents of skilled nursing facilities. It is a type of bacteria that lives on the surface of the skin and does not become a problem until it enters the body, usually via open wounds, such as pressure sores, breathing tubes, and catheters. Once MRSA enters the body, it can become extremely serious because it is often related to other infections including blood infections such as sepsis.

Because MRSA infections are very serious and can even lead to death, it is important to ensure that your loved one’s nursing home is taking the proper precautions to prevent and control the spread of infection. A recent article published in the Journal of Hospital Infection titled “Infection control and methicillin-resistant Staphylococcus aureus decolonization: the perspective of nursing home staff” studied infection prevention techniques in nursing homes. The study, which focuses specifically on MRSA infection control, interviewed nursing home staff and revealed some of the most common factors preventing caregivers from adhering to infection control procedures.

One of the top recurring factors that nurses cited as a reason for failing to follow infection control guidelines was lack of time. When nurses felt that they were under too much pressure, infection prevention and control were among the first caretaking practices to suffer. One nurse reportedly said that “Anything to do with infection control is more time consuming…you’re always working short staffed…that’s where bad practice comes in.” Usually, when nurses feel pressed for time, it is because the nursing home is understaffed. As this study has confirmed, nursing homes are unable to effectively prevent and control the spread of infection if they are inadequately staffed. Avoid putting your loved on at risk for contracting dangerous infections by ensuring that his or her nursing home is fully staffed.

Additionally, it is also important to ensure that the nursing staff is one dedicated to providing a high standard of care to your loved one. Many nurses reported that even if they adhered to infection prevention guidelines, their efforts were often nullified by other staff members who chose to forgo these infection control procedures. Under these circumstances, the nurses felt that inactive management was responsible for failing to enforce infection control guidelines among their colleagues. It was also found that employees who did not provide direct care to patients were most likely to forgo infection control procedures because they did not feel personally connected with patients. However, the nursing home is responsible for ensuring a cohesive staff that adheres to all rules and regulations regardless of whether or not they provide direct care to patients.

Despite nurses’ pleas to administrators and directors of nursing to enforce or improve infection control regulations, the study revealed that most skilled nursing facilities waited until after massive outbreaks of infection to implement any guidelines at all. It is completely unacceptable and egregious that some nursing homes wait until after many of their residents have suffered infections before taking steps to improve their infection control guidelines. Infection control must be precautionary, not something that happens only after the fact.

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A new study published in the Journal of American Medical Directors Association, looks into the care of dementia in nursing homes. The researchers focused the diagnosis and treatment aspects of dementia, finding very low levels of each in nursing homes in the US and across Europe. Knowledge about dementia and how to properly care for those suffering is an important issue in nursing homes, as there is usually a high percentage of dementia patients. This means that nursing home staff must be trained and knowledgeable in how to identify, care for, and properly medicate dementia patients.

In America, patients suffering from diagnosed dementia generally make up from 26 to 48% of nursing home populations. This number is probably even higher as patients with general cognitive impairment are not included. Many residents also go undiagnosed, mainly due to a lack of knowledge about the condition on the part of nursing home staff. This recent study has identified that roughly 1/3 of all dementia go undiagnosed, resulting in them never receiving any treatment or specialized care. Official diagnosis with dementia is important as it shapes how the individual care plan is formed. Dementia patients are more susceptible to falls, so special precautions and observation need to be used to prevent such events. More direct care is needed to care for nursing home residents diagnosed with dementia.

Direct care staff are frequently untrained in the identification and care of common nursing home ailments, including dementia. There are two main medications recommended for dementia: cholinesterase inhibitors (ChEIs) and memantine, an N-methyl-D-aspartate receptor antagonist. These two treatments work especially for dementia due to Alzheimer’s and Parkinson’s. The drug can help lessen behavioral problems and aggressive outbursts, meaning that the patient does not have to be restrained and can maintain a more normal and freer lifestyle. This means that the intensity of direct care necessary is lessened, decreasing the possibility of staff burn-out, which is more common when caring for dementia patients. And yet 26 to 60% of patients remain untreated. And even when they are prescribed, it is not uncommon for their use to be discontinued, commonly due to lack of funding. These medications can be beneficial to the patient, and the nursing home facility, so it is important that staff are well informed about their use and in identifying which patients have dementia and are thus can be helped by their use.

Unfortunately due to understaffing and the lack of training in care facilities, there are not enough qualified nursing staff to adequately monitor and assist these patients and unnecessary physical restraints are used to subdue them. Antipsychotic drugs used excessively can act as chemical restraints and benefit from these medications is usually outweighed by the harmful side effects of the drugs. It is important that medication should be individually tailored to each patient’s health needs and not used recklessly and improperly, as happens when used as a chemical restraint. The use of uncalled for restraints, due to a dearth of trained nursing staff, is against the Patients’ Bill of Rights. Nursing homes are required to employ enough staff to individually care for all of their residents. Understaffing can also result in the preventable spread of common diseases and pressure ulcers.

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You go to a hospital to get better, or at least to receive what medical assistance as may be possible. What you do not expect is for the hospital to make you worse, to give you a new disease. This is exactly what has allegedly happened to patients at Exeter Hospital in New Hampshire. At least 20 people have been confirmed as testing positive for Hepatitis C. During their stay at Exeter they were possibly infected by contaminated needles and equipment. Many people who were hospital residents during the time when the infection was present are currently being tested with their results pending. The government has lent its assistance to the matter and designated two nearby healthcare facilities as alternative testing sites to expedite the process.

The source of the Hep C outbreak has likely been traced to a hospital employee. This person used intravenous drugs while on the job and possibly contaminated syringes that were later used on patients. A class action lawsuit has been filed against Exeter Hospital for their negligence in allegedly allowing this employee to cause the outbreak. It is a hospital’s responsibility to ensure that proper safety procedures are put in place to prevent events like this from occurring. As of now, there are 44 affected people as part of the lawsuit, but this number could easily grow as more than 1,000 were possibly at risk from exposure.

Healthcare facilities, such as Exeter Hospital, are responsible to their patients; they are required to provide a safe environment, free of threats and harm, to those under their care. There must be an adequate number of trained staff, who are properly supervised and monitored, to prevent the type of damage that allegedly occurred at Exeter. Unfortunately, it is very common, especially in skilled nursing facilities, for there not to be enough qualified care givers. Understaffing can be very dangerous and is a contravention of patients’ rights statutes. Studies have shown that understaffed facilities are more likely to have occurrences of harmful, and even fatal, mistakes by care personnel. Patient quality of life is also adversely affected.

Pressure sores are a common side effect of an understaffed and under-educated facility. Bedsores can be avoided by relieving stress on sensitive areas and maintaining skin health through diet and exercise. Unfortunately, many residents in skilled nursing homes are malnourished, which has a marked negative impact on their risk factor for contracting pressure ulcers and other diseases. Nursing home patients who are malnourished or dehydrated are much more susceptible to infections such as methicillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile, and influenza. When healthcare facilities provide ample nursing staff to maintain and monitor each patient’s health and status, it is much easier to prevent the spread and outbreak of these harmful diseases. Care providers should be educated in the identification and care of common infections and pressure sores.

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The long awaited Supreme Court verdict on the Patient Protection and Affordable Care Act (dubbed Obamacare), has come back in mainly favor of the new law. In a close ruling, five Justices, including Chief Justice John Roberts, upheld Obamacare with the remaining four dissenting. Although the majority of the law was accepted, Chief Justice Roberts quashed certain aspects as unconstitutional, in violation of the balance of federal and state power. The ruling upheld the new law as an acceptable use of congressional power to “lay and collect taxes”. But the provision for the government to withhold Medicaid funds from non-compliant states was rejected. Under the ruling, Congress will only be able to withhold extra funds meant to ease the exchange to the new system, but not take away the existing state Medicaid budget in its entirety.

The effects of the Supreme Court ruling on the healthcare industry are being debated. Pundits are already acknowledging the important role this will play in the upcoming presidential election, but it is really too early to tell what the implementation of the law will mean for healthcare agencies, patients, and insurance companies in the long run. The full provisions of Obamacare do not come into play until January 1st, 2014, but some effects are already being felt. The court decision has affected the stock prices of the healthcare industry, with hospitals up but insurance and pharmaceutical company prices dropping. There are some new developments that the healthcare industry can be sure of. Medicaid will be expanded, with a larger percentage of the population now being financially eligible. It is expected that 50 million uninsured people will gain access to insurance under this act. Medicare is also greatly affected, as many expensive prescription medications will now be covered and available as well as an elimination of co-payments for many types of medical procedures. This is of benefit to many of those in nursing homes, who are commonly on Medicare benefits.

With the requirement for all Americans to be insured, insurance companies are now required to accept in people with pre-existing conditions, who would commonly have been rejected, and not charge a premium for the coverage. While this is certainly beneficial for individuals, the financial toll this could take on insurance companies could be great. Some analysts contend that the law will actually end up benefitting insurance companies, but most agree that the price of healthcare will continue going up and future reevaluations and budget changes will probably be necessary.

As with the implementation of any new system, it is likely that many institutions will have a difficult period during the transition. The effect of 50 million newly insured people on the healthcare system could be a strain. For nursing homes, having to house and care for the additional numbers of patients could lead to problems in overcrowding and understaffing. The next few years may be an unsteady time for the quality of nursing home care. Medicare and Medicaid are integral in funding skilled nursing facilities, so the new changes to those programs are bound to have reverberating impacts.

With the many changes to the healthcare industry coming up under Obamacare, it is vital that nursing homes be monitored to ensure they are providing the health and wellbeing of their residents and upholding the Patient’s Bill of Rights. No matter what happens, all those residing in skilled nursing facilities should be free of avoidable infections, pressure sores, and injury from falling.

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