Society’s Share of the Cost of Bad Nursing Home Care – Big Medicare & Medicaid Bucks

Think only insurance companies pay for medical treatment associated with decubitus ulcers? Think again. A recent consumer research study reveals the following alarming nursing home abuse and hospital patient neglect facts:

75% of nursing home residents will suffer a fall at some point.

In a 100 bed facility, on average, there are 100-200 falls per year. 1/4 of these falls will require medical attention. Most of these nursing home resident fall victims rely on Medicare and Medicaid so the federal government (i.e. tax dollars) pay for these preventable injuries.

10% – 25% of long term acute care nursing home residents that suffer falls suffer from fractures.

In 2006, there were 503,300 total hospital stays with decubitus ulcers (bedsores) listed as an admitting diagnosis. This marks a nearly 80% increase since the early 1990s.

Adult decubitus ulcer hospital stays totaled $11 billion in hospital costs.

Most Decubitus Ulcer Hospital Stays Paid by Medicare

Medicare is the primary payer for decubitus ulcer (bedsore) related hospital visits

Over 90 percent of decubitus ulcer wound-related hospitalizations were accompanied by other conditions, such as septicemia, UTI (urinary tract infection) and pneumonia.

Decubitus ulcer hospitalizations (in comparison to non-pressure wound hospitalizations) were more often discharged to a long-term care facility (nursing home and/or rehab center) and more likely to result in death.

~74% of patients hospitalized with a pressure ulcer diagnosis were 65 years and older. Conversely, ~55% percent of adult patients with a principal diagnosis of pressures ulcers were 65 or older.

Medicare is the primary payer of adult stays related to pressure ulcers (75% of all decubitus ulcer admissions).

Medicare (by and through the US government) paid in 75% of all decubitus ulcer related hospitalizations.

Common co-diagnoses with decubitus ulcer hospitalizations are paraplegia, parlysis, malnutrition, malnourishment, dehydration, diabetes, electrolyte deficiency and dementia.

There were 503,300 hospital stays in 2006 where decubitus ulcers (bedsores) were an admitting diagnosis. This marks a 79% increase from 1993. There were about 281,300 hospitalizations stemming from decubitus ulcer hospitalizations. Hospitalizations including a co-diagnosis of decubitus ulcers increased by 86.4 percent in 2006, while hospitalizations exclusively for decubitus ulcers increased by 27.2 percent.

Hospitalizations for adult patients suffering from decubitus ulcers totaled $11.0 billion in 2006.

Medicare covered about 74% percent of these hospitalizations.

Medicaid covers the second-most amount of pressure wound decubitus hospital visits. Patients on Medicaid accounted for an additional 12.5% of hospitalizations with a primary admission diagnosis of decubitus ulcers.

Private pay (private insurance) patients account for less than 10% of decubitus ulcer hospital patients

Patient decubitus ulcers are incredibly expensive for our government, as the bulk of the pressure sore hospital payments are paid through Medicare and Medicaid. Tragically, pressure sores requiring hospital visits are preventable. Existing decubitus ulcers can be treated through good care if caught early. If you or a family member suffered from a decubitus ulcer while a nursing home resident or a hospital patient, do something about the abuse. Speak with the state department of health or elder affairs, report the abuse, speak with a qualified decubitus ulcer sore lawyer and learn about your rights and options in filing a decubitus ulcer lawsuit.

We are available for a free decubitus ulcer case evaluation at (561) 316-7207. 

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