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Defending against lawsuits may divert considerable resources from nursing home quality improvement efforts

Nursing homes, many of them already struggling to keep financially solvent, used considerable funds in 2001 to defend against lawsuits, more than half of them filed in Florida and Texas, according to a Web-based survey of U.S. attorneys. This rise in nursing home litigation raises concern about the quality of care in nursing homes. Furthermore, the money these facilities spend to defend against lawsuits diverts resources from resident care, which may further exacerbate problems in quality of care, caution Harvard University researchers, David G. Stevenson and David M. Studdert, L.L.B., Sc.D., M.P.H. Their work was supported in part by the Agency for Healthcare Research and Quality (K02 HS11285).

The researchers conducted an online survey of plaintiff and defense attorneys who practice in the area of nursing home litigation about the details of the claims they handled in 2001. The 278 responding attorneys (from 37 States) and their firms were involved in 4,677 and 8,256 claims, respectively, in the year prior to the survey. More than half of these claims were in Florida and Texas, States that account for 10 percent of U.S. nursing home residents. More than half of the claims nationwide were for wrongful deaths, followed by pressure ulcers/bed sores (42 percent), dehydration/weight loss (32 percent), emotional distress (30 percent), falls (nearly 30 percent), and other problems.

The average recovery amount among paid claims—whether resolved in or out of court—was about $406,000 per claim, nearly twice the level of a typical medical malpractice claim ($207,000). The estimated worth of the open claims analyzed represent 2.3 percent of the $99 billion spent on nursing home care nationwide in 2001 (60 percent coming from Medicaid and Medicare), and they amount to 23 percent of Florida's and 15 percent of Texas' annual nursing home expenditures. Evaluation of the cost-effectiveness of nursing home quality improvement initiatives should consider their potential to reduce the number and severity of lawsuits, suggest the researchers.

See "The rise of nursing home litigation: Findings from a national survey of attorneys," by Mr. Stevenson and Dr. Studdert, in the March 2003 Health Affairs 22(2), pp. 219-229.

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