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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

  • 20160500.0-00011.pdf

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