About 20% of Medicare patients receiving care at skilled nursing facilities have endured various levels of preventable harm by medical professionals, a government investigation found.

The Department of Health and Human Services’ Office of Inspector General (IG) reviewed hundreds of cases from more than 600 nursing homes and discovered 22% of patients experienced adverse events during their stays. Another 11% suffered “temporary harm” events. These problems include patients getting overdoses of anticoagulants, falls, blood clots, wound-site infections, and urinary tract infections.

Inspectors determined that 59% of all adverse and temporary harm events could have been avoided by nurses and other staff.

The preventable harm was due to substandard treatment, inadequate monitoring, and failure or delay of care, according to the IG’s report (pdf).

More than half of the individuals who were harmed wound up back in the hospital for treatment, which cost Medicare $208 million in August 2011 alone.

Patient safety experts said the report demonstrated that regulators need to take action to ensure proper patient care at nursing facilities. Nearly half of people over 65 will spend time in a nursing home sooner or later.

“[The report] tells us what many of us have suspected—there are vast areas of healthcare where the field of patient safety has not matured,” Dr. Marty Makary, a physician at Johns Hopkins Medicine in Baltimore who researches healthcare quality, told ProPublica.

Senator Bill Nelson (D-Florida), chairman of the Senate Special Committee on Aging, said Medicare patients “deserve better” treatment at nursing homes. He added that he would demand better inspections at these facilities by federal officials.

-Noel Brinkerhoff

To Learn More:

Adverse Events in Skilled Nursing Facilities: National Incidence Among Medicare Beneficiaries (Office of Inspector General, Department of Health and Human Services) (pdf)

One Third of Skilled Nursing Patients Harmed in Treatment (by Marshall Allen, ProPublica)

Reports on Nursing Home Fraud and Neglect Get Little Notice (by Ken Broder, AllGov California)

92% of Nursing Homes Employ Ex-Convicts (by Noel Brinkerhoff, AllGov)