Obama Administration Cracks Down On Nursing Home Arbitration Clauses
A new rule from the Centers for Medicare & Medicaid Services would bar nursing homes from turning over claims of elder abuse, sexual harassment or even wrongful death to a private system to settle disputes.
The New York Times: U.S. To Bar Arbitration Clauses In Nursing Home Contracts
The federal agency that controls more than $1 trillion in Medicare and Medicaid funding has moved to prevent nursing homes from forcing claims of elder abuse, sexual harassment and even wrongful death into the private system of justice known as arbitration. An agency within the Health and Human Services Department on Wednesday issued a rule that bars any nursing home that receives federal funding from requiring that its residents resolve any disputes in arbitration, instead of court. (Silver-Greenberg and Corkery, 9/28)
Modern Healthcare: Obama Administration Cracks Down On Nursing Homes’ Use Of Binding Arbitration
A new CMS rule will bar nursing homes from compelling residents to settle disputes in arbitration as a condition of admission and introduces new requirements aimed at improving the quality of care and reducing unnecessary hospital readmissions. (9/28)
This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
The federal agency that controls more than $1 trillion in Medicare and Medicaid funding has moved to prevent nursing homes from forcing claims of elder abuse, sexual harassment and even wrongful death into the private system of justice known as arbitration.
An agency within the Health and Human Services Department on Wednesday issued a rule that bars any nursing home that receives federal funding from requiring that its residents resolve any disputes in arbitration, instead of court.
The rule, which would affect nursing homes with 1.5 million residents, promises to deliver major new protections.
Clauses embedded in the fine print of nursing home admissions contracts have pushed disputes about safety and the quality of care out of public view.
The system has helped the nursing home industry reduce its legal costs, but it has stymied the families of nursing home residents from getting justice, even in the case of murder.
A case involving a 100-year-old woman who was found murdered in a nursing home, strangled by her roommate, was initially blocked from court. So was a case brought by the family of a 94-year-old woman who died at a nursing home in Murrysville, Pa., from a head wound. The cases were the subject of a front-page article in The New York Times last November.
“The sad reality is that today too many Americans must choose between forfeiting their legal rights and getting adequate medical care,” Senator Patrick Leahy, a Democrat of Vermont, said in a statement on Wednesday.
The nursing home industry reacted strongly against the change. Mark Parkinson, the president and chief executive of the American Health Care Association, a trade group, said in a statement on Wednesday that the change on arbitration “clearly exceeds” the agency’s statutory authority and was “wholly unnecessary to protect residents’ health and safety.”
The new rule on arbitration came after officials in 16 states and the District of Columbia urged the government to cut off funding to nursing homes that use the clauses, arguing that arbitration kept patterns of wrongdoing hidden from prospective residents and their families.
With its decision, the Centers for Medicare and Medicaid Services, an agency under Health and Human Services, has restored a fundamental right of millions of elderly Americans across the country: their day in court.
It is the most significant overhaul of the agency’s rules governing federal funding of long-term care facilities in more than two decades.
And the new rule is the latest effort by the Obama administration to rein in arbitration’s parallel system of justice that was quietly built over more than a decade.
In May, the Consumer Financial Protection Bureau, the nation’s consumer watchdog, unveiled the draft of a rule that would prevent credit card companies and other financial firms from using arbitration clauses that bar consumers from banding together in a class-action lawsuit.
While Democrats, including Mr. Leahy, have tried to get rid of arbitration through legislation, their efforts have met resistance from various industry groups. The efforts by the consumer agency and now Health and Human Services do not require congressional approval.
Like other rules put forth by the administration, the rule on nursing homes that receive federal funding could be challenged in court. But absent those challenges, the rule is scheduled to go into effect by November. Only future admissions would fall under the new rule.
The nursing home industry has said that arbitration offers a less costly alternative to court. Allowing more lawsuits, the industry has said, could drive up costs and force some homes to close.
But some government officials and elder care lawyers see a different rationale. For corporations, they say, arbitration also potentially keeps embarrassing practices under wraps.
The nursing home rule, which was first proposed in July 2015, was aimed at improving disclosure. The agency began to re-examine the rule after a chorus of patient groups raised concerns about the widespread use of arbitration.
The final version of the rule went a step further than the draft, cutting off funding to facilities that require arbitration clauses as a condition of admission.
Lawyers who work with the elderly say that people are being admitted to nursing homes at one of the most stressful moments of their lives. Distraught and often desperate for a room, prospective residents do not fully grasp what they are signing, the lawyers say.
Sometimes, that does not matter. Judges are bound by a pair of Supreme Court decisions, in 2011 and 2013, that blessed the widespread use of arbitration clauses. Those decisions have made it virtually impossible to overturn clauses, even those signed by the most vulnerable nursing home residents.
An appeals court refused to throw out an arbitration clause signed by a man who could not read or sign his name, reasoning that “illiteracy alone is not a sufficient basis for the invalidation of an arbitration agreement.”
In the last decade, arbitration clauses have affected things like cellphone contracts, employment agreements and student loans.
But even as the use of arbitration clauses spread, little was known about what happened to those who took their chances there. Companies argued that arbitration offered a simpler, swifter and less expensive alternative to court, without the headaches and delays.
Those claims, though, were largely anecdotal because arbitrations are confidential and there is no federal database that records their outcomes.
In a yearlong investigation, The Times tried to pierce the veil, getting inside the secretive proceedings. To do that, The Times examined records from more than 25,000 arbitrations between 2010 and 2014 and interviewed hundreds of lawyers, arbitrators, plaintiffs and judges in 35 states.
The proceedings bear little resemblance to court. They have been conducted in the offices of lawyers who represent the companies accused of wrongdoing.
In the case of nursing homes, The Times found many troubling examples where issues of abuse and potential neglect never made it into the public light because they were blocked from court.
In May 2014, for example, a woman with Alzheimer’s was sexually assaulted two times in two days by residents at a nursing home in Lemon Grove, Calif. A subsequent investigation by the state’s department of public health found the nursing home “failed to protect” the woman.
But when her family tried to hold the nursing home accountable in court, their case was scuttled because of an arbitration clause. Ultimately, they gave up and settled with the nursing home.
Many hospitals leave their staff to handle their own uniform cleaning at home, and at least one group of researchers has found that to be an unhealthy practice. Typical home laundry processes simply won’t remove bacteria from clothing.
Researchers at DeMontfort University in Leicester, England, surveyed 265 hospital staff workers at four hospitals to learn more about their uniform washing habits. They asked staff how often they washed their uniforms, the temperatures they wash them at and whether uniforms were washed separately from other clothing.
The report authors – DMU microbiologist Katie Laird , PhD student Kate Riley and Principal Lecturer John Williams, from the university’s School of Fashion and Textiles – have called for national guidelines to be introduced and have also recommended washing of hospital uniforms is moved back in-house.
It is common for staff to launder their uniforms at home as it reduces NHS costs and is more convenient. But as we’ve noted, the cost-cutting and convenience comes at an unacceptable cost. The report writers have suggested that moving uniform cleaning back in-house would rule out any possibilities of not meeting a national standard.
In this piece, Enteric Virus Survival during Household Laundering and Impact of Disinfection with Sodium Hypochlorite, it was found that washing with detergent alone was not found to be effective for the removal or inactivation of enteric viruses, as significant concentrations of virus were found on the swatches (reductions of 92 to 99%). It was also demonstrated that viruses are readily transferred from contaminated cloths to uncontaminated clothes. The use of sodium hypochlorite reduced the number of infectious viruses on the swatches after washing and drying by at least 99.99%. Laundering practices in common use in the United States do not eliminate enteric and respiratory viruses from clothes. The use of bleach can further reduce the numbers of enteric viruses in laundry.
Sanitation of Low Temperature Home Laundry experiments with a procedure that was developed to closely simulate the home laundry process. It measured the ability of the entire laundry process to remove bacteria from fabrics, including the mechanical action of washing, rinsing and tumble drying. It finds:
The use of detergent alone was not effective in sanitizing fabrics when water of low temperature was used in the laundry.
Detergent concentration had no effect on the numbers of bacteria surviving treatment.
The nonionic non-phosphate detergent resulted in lower bacterial counts when used on the terry cloth, whereas the anionic phosphate detergent was slightly more effective on the polyester/cotton sheeting.
The number of bacteria surviving treatment was reduced slightly by raising the wash water temperature from 65°F to 105°F.
Use of a disinfectant significantly reduced bacteria counts.
Increasing the disinfectant concentration reduced bacteria survival with the medium concentration providing an acceptable level of reduction.
Drying at 160° F yielded lower counts than drying at 80°F.
Welcome to our discussion about some of the challenges and potential solutions to infection control
Carbapenems: Past, Present, and Future Krisztina M. Papp-Wallace,1,2 Andrea Endimiani,1,2,3 Magdalena A. Taracila,2 and Robert A. Bonomo1,2,4,5* Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio 441061 ; Institute for Infectious Diseases, University of Bern 3010, Bern, Switzerland3 ; and Departments of Medicine,2 Pharmacology,4 and Molecular Biology and Microbiology,5 Case Western Reserve University, Cleveland, Ohio 44106
In this review, we summarize the current “state of the art” of carbapenem antibiotics and their role in our antimicrobial armamentarium. Among the -lactams currently available, carbapenems are unique because they are relatively resistant to hydrolysis by most -lactamases, in some cases act as “slow substrates” or inhibitors of -lactamases, and still target penicillin binding proteins. This “value-added feature” of inhibiting -lactamases serves as a major rationale for expansion of this class of -lactams. We describe the initial discovery and development of the carbapenem family of -lactams. Of the early carbapenems evaluated, thienamycin demonstrated the greatest antimicrobial activity and became the parent compound for all subsequent carbapenems. To date, more than 80 compounds with mostly improved antimicrobial properties, compared to those of thienamycin, are described in the literature. We also highlight important features of the carbapenems that are presently in clinical use: imipenem-cilastatin, meropenem, ertapenem, doripenem, panipenem-betamipron, and biapenem. In closing, we emphasize some major challenges and urge the medicinal chemist to continue development of these versatile and potent compounds, as they have served us well for more than 3 decades.
Antibiotic resistance – when bacteria stop responding to the drugs designed to kill them – is a healthcare “hot topic” and possibly the most significant infectious disease threat we currently face.
The Journal of the American Medical Association Internal Medicine recently published a study in which CDC experts revealed that although the overall rates of antibiotic use in U.S. hospitals have not changed over time, there have been significant changes in the types of antibiotics prescribed.
More than half of patients receive at least one antibiotic during their hospital stay, and the study highlighted an alarming discovery – the types of antibiotics often considered to be the most powerful were also those with the largest increases in use. The use of carbapenems, often called “last resort” antibiotics, increased by 37%. Bacteria that develop resistance to carbapenems are referred to as “superbugs, “nightmare bacteria” or carbapenem-resistant enterobacteriaceae (CRE) and can be especially difficult to treat.
Although prescribing antibiotics remains common and the use of the most powerful antibiotics is on the rise, a number of studies have shown there are a number of important opportunities for hospitals to improve antibiotic use. CDC has called on all hospitals to improve antibiotics through antibiotic stewardship. “We are committed to combatting antibiotic resistance by ensuring that every hospital in America has an active antibiotic stewardship program so that every patient gets the best possible treatment for their condition.” said Dr. Arjun Srinivasan (CAPT, USPHS), Associate Director for CDC’s Healthcare-Associated Infection Prevention Programs.
Check out the full article and find prescribing guidelines and improvement resources here.
Share with your colleagues and join the conversation!
Key facts • Health care-associated infections, or infections acquired in health-care settings are the most frequent adverse event in health-care delivery worldwide. • Hundreds of millions of patients are affected by health care-associated infections worldwide each year, leading to significant mortality and financial losses for health systems. • Of every 100 hospitalized patients at any given time, 7 in developed and 10 in developing countries will acquire at least one health care-associated infection. • The endemic burden of health care-associated infection is also significantly higher in low- and middle-income than in high-income countries, in particular in patients admitted to intensive care units and in neonates. • While urinary tract infection is the most frequent health care-associated infection in high-income countries, surgical site infection is the leading infection in settings with limited resources, affecting up to one-third of operated patients; this is up to nine times higher than in developed countries. • In high-income countries, approximately 30% of patients in intensive care units (ICU) are affected by at least one health care-associated infection. • In low- and middle-income countries the frequency of ICU-acquired infection is at least 2─3 fold higher than in high-income countries; device-associated infection densities are up to 13 times higher than in the USA. • Newborns are at higher risk of acquiring health care-associated infection in developing countries, with infection rates three to 20 times higher than in high-income countries. What are health care-associated infections? Health care-associated infections, or “nosocomial” and “hospital” infections, affect patients in a hospital or other health-care facility, and are not present or incubating at the time of admission. They also include infections acquired by patients in the hospital or facility but appearing after discharge, and occupational infections among staff. Most countries lack surveillance systems for health care-associated infections. Those that do have systems often struggle with the complexity and lack of standardized criteria for diagnosing the infections. While this makes it difficult to gather reliable global information on health care-associated infections, results from studies clearly indicate that each year, hundreds of millions of patients are affected by health careassociated infections around the world. Health care-associated infections only usually receive public attention when there are epidemics. Although often hidden from public attention, the very real endemic, ongoing problem is one that no institution or country can claim to have solved, despite many efforts. Health care-associated infections in high-income countries All reasonable precautions have been taken by the World Health Organization to verify the information contained in this document. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. WHO acknowledges the Hôpitaux Universitaires de Genève (HUG), in particular the members of the Infection Control Programme, for their active participation in developing this material. At any given time, the prevalence of health care-associated infection in developed countries varies between 3.5% and 12%. The European Centre for Disease Prevention and Control reports an average prevalence of 7.1% in European countries. The Centre estimates that 4 131 000 patients are affected by approximately 4 544 100 episodes of health care-associated infection every year in Europe. The estimated incidence rate in the United States of America (USA) was 4.5% in 2002, corresponding to 9.3 infections per 1 000 patient-days and 1.7 million affected patients. According to a recent European multicentre study, the proportion of infected patients in intensive care units can be as high as 51%; most of these are health careassociated. Approximately 30% of patients in ICUs are affected by at least one episode of health care-associated infection. The longer patients stay in an ICU, the more at risk they become of acquiring an infection. On average, the cumulative incidence of infection in adult high-risk patients is 17.0 episodes per 1000 patientdays. High frequency of infection is associated with the use of invasive devices, in particular central lines, urinary catheters, and ventilators. Health care-associated infections in low- and middle-income countries Limited data, often of low quality, are available from low- and middle-income countries. However, recent analysis by WHO found that health care-associated infections are more frequent in resource-limited settings than in developed countries. At any given time, the prevalence of health care-associated infection varies between 5.7% and 19.1% in low- and middle-income countries. Average prevalence is significantly higher in high- than in low-quality studies (15.5% vs 8.5%, respectively). The proportion of patients with ICU-acquired infection ranged from 4.4% to 88.9% with a frequency of overall infections as high as 42.7 episodes per 1000 patientdays. This is almost three times higher than in high-income countries. Furthermore, in some developing countries, the frequency of infections associated with the use of central lines and ventilators and other invasive devices can be up to 19 times higher than those reported from Germany and the USA. Newborns are also at higher risk, with infection rates in developing countries 3-20 times higher than in high-income countries. Among hospital-born babies in developing countries, health care-associated infections are responsible for 4% to 56% of all causes of death in the neonatal period, and 75% in South-East Asia and Sub-Saharan Africa. Surgical site infection is the leading infection in the general patient population in countries with limited resources, affecting up to two third of operated patients and with a frequency up to nine times higher than in developed countries. What factors put patients at risk of infection in health-care settings? Several factors can cause health care-associated infections. Some of these factors are present regardless of the resources available: • prolonged and inappropriate use of invasive devices and antibiotics; • high-risk and sophisticated procedures; All reasonable precautions have been taken by the World Health Organization to verify the information contained in this document. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. WHO acknowledges the Hôpitaux Universitaires de Genève (HUG), in particular the members of the Infection Control Programme, for their active participation in developing this material. • immuno-suppression and other severe underlying patient conditions; • insufficient application of standard and isolation precautions. Some determinants are more specific to settings with limited resources: • inadequate environmental hygienic conditions and waste disposal; • poor infrastructure; • insufficient equipment; • understaffing; • overcrowding; • poor knowledge and application of basic infection control measures; • lack of procedure; • lack of knowledge of injection and blood transfusion safety; • absence of local and national guidelines and policies. What is the impact of health care-associated infections? As is the case for many other patient safety issues, health care-associated infections create additional suffering and come at a high cost for patients and their families. Infections prolong hospital stays, create long-term disability, increase resistance to antimicrobials, represent a massive additional financial burden for health systems, generate high costs for patients and their family, and cause unnecessary deaths. Such infections annually account for 37 000 attributable deaths in Europe and potentially many more that could be related, and they account for 99 000 deaths in the USA. Annual financial losses due to health care-associated infections are also significant: they are estimated at approximately €7 billion in Europe, including direct costs only and reflecting 16 million extra days of hospital stay, and at about US$ 6.5 billion in the USA. Financial costs attributable to health care-associated infections are poorly and variably reported in low- and middle-income countries. For instance, the economic burden of health care-associated infections in Belo Horizonte, Brazil, was estimated to be equal to US$ 18 million in 1992. In Mexican ICUs, the overall cost of one single health care-associated infection episode was US$ 12 155. In several ICUs in Argentina, the overall extra-cost estimates for catheter-related bloodstream infection and health care-associated pneumonia averaged US$ 4 888 and US$ 2 255 per case, respectively. What are the solutions to this problem? Many infection prevention and control measures, such as appropriate hand hygiene and the correct application of basic precautions during invasive procedures, are simple and low-cost, but require staff accountability and behavioural change. The main solutions and perspectives for improvement are: • identifying local determinants of the HCAI burden; • improving reporting and surveillance systems at the national level; All reasonable precautions have been taken by the World Health Organization to verify the information contained in this document. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. WHO acknowledges the Hôpitaux Universitaires de Genève (HUG), in particular the members of the Infection Control Programme, for their active participation in developing this material. • ensuring minimum requirements in terms of facilities and dedicated resources available for HCAI surveillance at the institutional level, including microbiology laboratories’ capacity; • ensuring that core components for infection control are in place at the national and health-care setting levels; • implementing standard precautions, particularly best hand hygiene practices at the bedside; • improving staff education and accountability; • conducting research to adapt and validate surveillance protocols based on the reality of developing countries; • conducting research on the potential involvement of patients and their families in HCAI reporting and control. WHO’s response WHO Patient Safety is actively working towards establishing effective ways of improving global health care and save lives lost to health care-associated infections. Within WHO Patient Safety, the Clean Care is Safer Care programme is aimed at reducing health care-associated infections globally and has placed improving hand hygiene practices at the core of achieving this. WHO Patient Safety works in collaboration with other WHO programmes, including regional and country offices supporting Member States, to reduce HCAI by assisting with the assessment, planning, and implementation of infection prevention and control policies, and timely actions at national and institutional levels. Related links WHO, Clean Care is Safer Care www.who.int/gpsc WHO, Infection Control http://www.who.int/csr/bioriskreduction/infection_control/en/index.html European Centre for Disease Prevention and Control (ECDC) http://www.ecdc.europa.eu/en/Pages/home.aspx Centre for Disease Prevention and Control (CDC) and National Healthcare Safety Network (NHSN) http://www.cdc.gov/nhsn/ International Nosocomial Infection Control Consortium http://www.inicc.org/english/index.php