Residents in New York City nursing homes experience painful and preventable bedsores at a rate almost 50 percent higher than the national average. In New York City, 16 percent of high-risk residents have one or more of the painful wounds, compared with 11 percent nationwide.
In 2011, according to an AARP analysis of the data reported to the federal Centers for Medicare & Medicaid Services, New York ranked 44th among states in preventing the development of sores among high-risk residents.
The wounds, clinically known as pressure sores or pressure ulcers, can set in when an immobilized patient is not moved regularly. Bones push through areas of soft skin, and openings in the flesh can deepen down to muscle and bone. The National Quality Forum, a patient safety organization, puts advanced pressure sores acquired in a facility on its inventory of preventable “serious reportable events,” a list that also includes wrong-site surgery and injury resulting from contaminated drugs.
Researchers who have studied pressure sores say that nursing homes frequently receive patients who already had sores before they arrived. “Those measures do not separate pressure ulcers that were on people who come into the facility from ones formed in the facility,” said William Spector Ph.D, a senior social scientist for the federal Agency for Healthcare Research and Quality, which funded the state grants.
So what accounts for the New York City facilities’ alarmingly high rates of pressure sores among nursing home residents? Federal data collected from nursing homes risks-adjusts for health conditions residents may have that can make development of pressure sores more likely, such as diabetes. But Spector contends that this risk adjustment fails to adequately account for factors that lead to higher rates at some nursing homes than others, like age and gender. Facilities willing to take in gravely ill patients can unfairly be penalized with a poor rating. Research on nearly 60,000 residents in New York State nursing homes also shows that even adjusting for other risk factors, black residents are more likely than white residents to develop pressure sores.
Officials at the state health department say they are looking to improve the facilities, not beat up on them. “Our goal isn’t to be punitive or to collect fines, but to make sure that the quality of care is being met,” said Jeffrey Hammond, a spokesman for the New York State Department of Health. He added that the department uses enforcement actions mainly in the event of repeat violations. “We don’t use fines to treat pressure sores.”
David Bruso, acting director at New York State Department of Health’s Bureau of Quality Assurance, the agency that oversees enforcement of penalties for nursing home violations, acknowledged that for these multi-million dollar facilities, fines capped at $2,000 are less a financial deterrent than simply a threat to a home’s public image.