Study Shows Nursing Home Lawsuits Are Not Related to Quality

There are often nursing home issues in the news, so how can you be sure your loved one is going to be treated with care and compassion? A new study finds that high quality nursing homes get sued almost as often as low-quality nursing homes.

The study illustrates that litigation does not lead to improvements in patient care. It also does not show that better nursing homes are recognized for their great care, with fewer lawsuits.

"Nursing homes that are at the very top of the heap in terms of quality don't experience that much less litigation than nursing homes that are at the bottom of the heap," said lead study author David Studdert, a law professor at the University of Melbourne in Australia. "It's not clear that by improving your quality dramatically you will lessen your risk of being sued."

Litigation encourages high-quality nursing home care, as it is a huge objective of the process, says co-author David Stevenson, an associate professor of health care policy at Harvard Medical School.

Most people would assume that if a nursing home has better care for their patients they are going to be free of lawsuits. The study found much different results.

"The results are sobering," Stevenson said. "One of the fundamental things that the risk of a malpractice claim is supposed to spur is deterring poor quality care. What we found was that the return on being a high-quality facility relative to a low-quality facility isn't great."

The research consisted of five large nursing home chains in the U.S. and they examined each home’s lawsuit details and outcomes. It was uncovered that during the period of 1998 and 2006, 4,716 people filed claims against 1,465 nursing homes. On average, each nursing home was sued once every two years. Yikes.

Twenty-seven percent of the allegations were fall-related injuries, 16 percent were pressure ulcers or bedsore and other claims included malnutrition, dehydration, excessive weight loss, medication errors, and physical or verbal abuse.

Payment was seen in 61 percent of the claims. This averaged about $200,000.

Nursing homes that ranked the best on quality procedures were only a little less likely to be sued. In any given year, nursing homes with the finest records (the top 10 percent) had a 40 percent risk of being sued, while the worst 10 percent of nursing homes had a 47 percent chance of being sued.

A measure of how well staffed a nursing home is, meaning the amount of most nurse's aide hours per resident-day, were also slightly less likely to get sued, but not by much – 45 percent compared to 41 percent annually for those with the lowest staffing levels.

One aspect of the study, which showed major difference in the likelihood of lawsuits, was regarding pressure ulcers or bedsores. Nursing homes with the lowest pressure ulcer rates had a 6 percent chance of being sued in a given year, versus 11 percent for the lowest-quality nursing homes.

Taken as a whole, for half of the 10 measures of quality, top nursing homes were slightly less likely to be sued than the worst nursing homes.

Concluding that lawsuits have little effect on quality of care, the authors say that other long-term efforts, such as public reporting of nursing home conditions and performance-based reimbursement schedules, may be needed to encourage improvements.

The authors said they study shows that there is no firm connection between a high-quality versus a low-quality nursing home's likelihood of being sued.

The authors said their study doesn't specifically address tort reform, and their findings indicate that even in regions where there is less litigation, there is no strong connection.

"The tort system is not working well in terms of deterrence, and it's not looking like you can fix that by any tweak to the system," Studdert said. "It looks fundamental."