Copyright ? 2016 Wolters Kluwer Health, Inc. All rights reserved.
LEGAL MATTERS
Legal Versus Common Sense Advocacy to Improve
Home Healthcare Quality
BARBARA BOSLER, JD, MHE, RHIA
This month as I focus on medi-cal malpractice, I uncovered
a myriad of law offices through-
out the nation trolling for home
healthcare cases. Reasons given
to contact these law firms for
possible monetary remedy were:
a) negligence by visiting nurses;
b) medication errors such as
failure to check for drug interac-
tions or provide needed medica-
tion at the proper times; c) poor
communication between the
home healthcare nurse and doc-
tors; d) poor human resources
sent to a patient?s home by
training or overall competence;
e) evidence of physical or ver-
bal patient abuse; f) poor care
coordination between acute and
home healthcare providers; g)
ignoring expressed concerns by
the patient or family members;
h) medical equipment failures;
i) wheel chair injuries and trans-
portation injuries; and j) over-
reliance on family members to
perform the responsibilities of
the home healthcare agency
(Berg, 2015; DeLuca & Wei-
zenbaum, 2016; The Cochran
Firm, 2015).
Interestingly, one site fo-
cused specifically on nurse mal-
practice, describing it as the
omission by the nurse to per-
form a task altogether or to
perform it incorrectly. Examples
were failure to take vital signs
completely and at the proper
time, failure to document ob-
servations, and making a mis-
take in administering food and
water (Berg, 2015). The causes
of action I would like to address
from those listed above and fun-
damental to all the others are
poor communication between
the patient, family, and health-
care providers, and poor care
coordination between acute and
home healthcare providers.
I am reminded of the tremen-
dous need for optimal communi-
cation and care coordination by
experiencing the acute care to
home healthcare transition with
a family member. When commu-
nication and care continuity pro-
tocols are in place and utilized,
care is optimal. When they are
not, the family is left to problem
solve. It has been a task of ad-
vocating for the patient, having
to make the best choice from all
bad choices, and screening out
poor healthcare systems and
individual providers to find the
best solution for the patient.
Three important resources were
uncovered, which can be used
by patients and family mem-
bers seeking the best home care
choice, providers trying to meet
and promote quality-of-care
initiatives, or legal experts at-
tempting to prove or disprove
legal causes of action when
there are breakdowns.
1. The National Association
of Home Care & Hospice
(NAHC) offers invaluable
questions to help identify
qualified home healthcare
providers. Highlights of
these questions are:
How long has this provider
been serving the community?
Does this provider sup-
ply literature explaining its
services, eligibility require-
ments, fees, and funding
sources?
How does this provider se-
lect and train its employees?
Are nurses or therapists
required to evaluate the
patient?s home care needs?
What does this entail? Are
patients, physicians, and
family members included?
Are patients and family
members included in devel-
oping the plan of care and
making care plan changes?
Is the patient?s course of
treatment documented, de-
tailing the specific tasks to
be carried out by each pro-
fessional caregiver? Does
the patient and his or her
family receive a copy of this
plan? Does this provider
take time to educate family
members on the care being
administered to the patient?
Does this provider assign
supervisors to oversee the
quality of care patients are re-
ceiving in their homes? How
often are visits made? How
does the agency follow up on
and resolve problems?
What are the financial
procedures of this provider?
Does the provider furnish
written statements explain-
ing all of the costs and
payment plan options asso-
ciated with home care?
What procedures does this
provider have in place to
handle emergencies? Are its
caregivers available 24 hours
a day, 7 days a week?
May 2016 Home Healthcare Now 281
Copyright ? 2016 Wolters Kluwer Health, Inc. All rights reserved.
When communication and care continuity
protocols are in place and utilized, care
is optimal.
How does this provider
ensure patient confidential-
ity? (NAHC, 2016).
NAHC further recommends
asking each home care provider
for a list of references from mul-
tiple consumers or stakeholders
who are most familiar with that
provider?s quality of service.
2. Ellenbecker et al. (2007)
remind us of the daunting
task of delivering home
care. Services provided
include nursing care;
physical, occupational,
and speech language ther-
apy; and social services.
There is a huge scope of
practice to manage be-
tween healthcare provid-
ers as well as between
healthcare providers and
the patient. Home health-
care goals are: to enhance
the patient?s quality of life
by improving their func-
tion to perform activities
of daily living, avoiding
hospitalizations, and living
with greater quality and
independence. The Centers
for Disease Control and
Prevention (2012) reported
over 12,200 home health-
care agencies and 4.7 mil-
lion patients are treated
annually. Ellenbecker et al.
recognized key problem
areas in meeting expecta-
tions: medication manage-
ment, nurse work environ-
ment, wound and pressure
ulcer management, falls,
and unplanned hospitaliza-
tions. Their work includes
quality measures to quan-
tify each problem with
summary result tables.
3. Mitchell et al. (2012) round
out this resource list with
their work on team-based
healthcare. They astutely
recognize that healthcare has
not always been described as
a team sport. The complexity
of the healthcare industry
and patient needs have re-
quired healthcare providers
and systems to work together.
Values of team-based care
are: effective communication
within the team, performing
roles and responsibilities
with discipline, thinking cre-
atively, maintaining humility,
and seeking continuous im-
provement. Team-based care
principles center on mutual
trust of each other and hav-
ing measurable processes
and outcomes for the goals
to be achieved. Care coordi-
nation ensures patient needs
and preferences for care are
understood and shared be-
tween providers and health-
care settings, including home
care. Waste, bad decisions
and practices, and conflicting
care plans are avoided with
good communication and
care coordination.
Legal advocacy always re-
mains an option when a breach
in care happens. However, home
healthcare patients and families
rely on the healthcare industry
to first do no harm. The In-
stitute of Medicine discussion
paper Communicating with Pa-
tients on Health Care Evidence
reports that 92% of people
agree that healthcare providers
should work as a team to co-
ordinate care and share health
information. For patients with
chronic conditions, 97% agreed
their care should be coordi-
nated. These findings strongly
support the conclusion that
?not only should care be co-
ordinated to increase quality,
but that patients already expect
to receive coordinated care.?
(Mitchell et al., 2012, p. 23).
Barbara Bosler, JD, MHE, RHIA, is a Veter-
ans Accredited Attorney at Law and former
Assistant Clinical Professor, College of Health
Professions, University of Detroit Mercy, De-
troit, Michigan.
The author declares no conflicts of interest.
Address for correspondence: Barbara Bosler,
JD, MHE, RHIA ([email?protected]).
REFERENCES
Berg, D. (2015). Medical malpractice claim
for nurse?s treatment error? Retrieved
from http://www.alllaw.com/articles/nolo/
medical-malpractice/nurse-treatment.html
Centers for Disease Control and Preven-
tion. (2011?2012). FastStats: Home health
care. Retrieved from http://www.cdc.gov/
nchs/fastats/home-health-care.htm
DeLuca, & Weizenbaum. (2016). Rhode-
Islandhome health care negligence
lawyer. Retrieved from http://www.
delucaandweizenbaum.com/Personal-In-
jury/Home-Health-Care-Negligence.shtml
Ellenbecker, C. H., Samia, L., Cushman,
M. J., & Alster, K. (2007). Patient safety
and quality in home health care. An
Evidence-Based Handbook for Nurses:
Vol 1. Retrieved from http://www.ncbi.
n l m . n i h . g o v / b o o k s / N B K 2 6 3 1 / p d f /
Bookshelf_NBK2631.pdf
Mitchell, P. M., Wynia, R., Golden, B., Mc-
Nellis, S., Okun, C. E., Webb, V., ?, Von
Kohorn, I. (2012). Core principles & val-
ues of effective team-based health care.
Discussion Paper, Institute of Medicine,
Washington, DC. www.iom.edu/tbc
National Association of Home Care & Hos-
pice. (2016). How do I select the right
home care provider. Retrieved from http://
www.nahc.org/consumer-information/
right-home-care-provider/
The Cochran Firm. (2015). Medical mal-
practice and nursing home neglect. Re-
trieved from http://www.cochranfirm.com/
practice-areas/personal-injury-attorney/
nursing-home-abuse-attorneys/medical-
malpractice-and-nursing-home-neglect/
DOI:10.1097/NHH.0000000000000396
282 Volume 34 | Number 5 www.homehealthcarenow.org
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