New Medicare and Medicaid guidelines will soon put pressure on nursing homes and other long-term care facilities to provide better wound-care for their residents. Under the revised pressure ulcer regulations (F-314), facilities will be unable to receive reimbursement from Medicare or Medicaid if the agencies deem the pressure ulcer to be avoidable.
According to McKnight’s Long Term Care News, up to 28% of all residents in long-term care facilities suffer from pressure ulcer’s. The cost for treatment of pressure ulcers is estimated to be more than $1.3 billion.
Under the current system, nursing homes and long-term care facilities may submit charges for pressure ulcer care to Medicare and Medicaid. Essentially, there is no economic incentive to provide preventative pressure ulcer care for most facilities. The new guidelines will put pressure on nursing home owners and administrators to readdress the way they provide care, or they their bottom lines will suffer.
Most facilities wound management guidelines are not adequate. ‘Most of the standards are below what is necessary to decrease the incidence of wounds and manage current wounds,” according to wound care expert, Margaret Bryant, PT.
The first step in providing better wound care is for facilities to provide better training for their staff. ‘Preventing and managing pressure ulcers takes a very aggressive approach–one that requires facility wide buy-in and multi-disciplinary involvement,’ says Heather Hettrick, PT, PhD, a director at American Medical Technologies Inc.
Even the most basic pressure ulcer prevention techniques are ignored or done improperly. In order to prevent pressure sores on heels, off-loading boots are the best choice. However, the boots must be properly sized and adjusted in order to successfully keep the heel in the air as the boots are intended. Improperly used boots are ineffective.
Similarly, caregivers in nursing homes must be educated in use of wound care ointments and lotions. Many caregivers are unaware that the detergents and petroleum based based products they commonly use may be causing more harm than help to residents with pressure ulcers. ‘Research has shown that the majority of the time, bedside nurses don’t even know what kind of dressing they’re applying, are not applying them correctly in about 88 percent of cases,” according to Cynthia Fleck, RN, BSN, ET/WOCN of Medline Industries.
There is hope. At Regency Hospital, a long-term care facility in Minneapolis, pressure ulcer prevention is clearly a priority. In addition to photographing every suspicious area on residents skin, the facility also checks for temperature and color changes which may be the early signs of skin impairment.
Most of Regency Hospital’s preventative techniques are basic. Hourly rounds look for the ‘Three P’s’ positioning, pottying, and pain. Music is played every two hours to remind residents and staff they need to change positions. ‘Turning wheel’s’ are used in each resident’s room to demonstrate to all caregivers what position to change the resident to next. The would care nurse at Regency Hospital, Kathy Irons, says it best, “we take a very proactive approach where everyone is held accountable.’