Placing your loved one in a reputable long-term care facility is just the
first step in ensuring they are well cared for. Regardless of complaints
or sanctions found during state and federal inspections (be they few or
many), residential facilities are often understaffed. This fact in concert
with the advanced needs of elder patients can create a worrisome environment.
As an advocate for your loved one, you’ve got federal (and sometimes
state) law on your side to insist that your relative or friend gets the
quality of care they deserve. The Code of Federal Regulations (CFR) and
your state law contain many protections.
The following are just a sample from the Code of Federal Regulations:
Each nursing home resident is entitled to a personalized “care plan,”
that addresses their respective medical and safety needs. This plan must
have an anticipated goal of ensuring a resident/patient maintains their
highest practicable physical, mental and psychosocial well being. Federal
law requires that facilities do a full assessment of a resident’s
condition within 14 days of admission, and at least every 12 months thereafter.
A care plan should include measurable objectives and timetables.
In my experience with friends or family members that have loved ones in
nursing homes, it is not at all uncommon for facilities to put forth the
idea that Family can only visit during visiting hours. Not only is this
mendacious, Federal legislation actually specifically prohibits such rules.
42 CFR 483.10(j) allows immediate family the right to visit at any time.
In fact, we often advise clients to visit during off-hours so that they
can perceive their loved one’s environment when staff members aren’t
Skilled Care or Rehabilitation Services
In the past, we have had clients tell us that their parents’ nursing
home facility has terminated skilled care or rehab services because their
Mom or Dad weren’t making progress. Again, however, this is contrary
to federal and often times, state law. Assuming that the resident would
benefit from such services, a facility is charged with trying to maintain
their condition regardless of progress. All facilities are required to
make sure that a person’s ability to carry out activities of daily
living doesn’t deteriorate. The only exception would be if the individual’s
medical condition deteriorates to such an extent that termination of the
activity is in their better interest.
Nutrition and Eating
Feeding tubes may be used only if absolutely necessary. Long-term care
facilities are not permitted to utilize them solely to address a resident
who eats slowly or needs extra help cutting or eating food. The facility
must provide whatever help a resident needs to eat without extrinsic medical
involvement such as Gastric or G-Tubes. Feeding tubes should only be placed
with qualified physician orders, and where absolutely necessary to maintain health.
This has obviously been and remains one of the hot button issues with
nursing homes; however, the answer is relatively simple. The only reason
or purpose a facility has for utilizing restraints is to treat an individual’s
medical condition. They should not and cannot be used for the convenience
of the staff (prevent wandering) or to reduce staff for a facility.
Guaranty of Payment
42 CFR 483.12(d) prohibits Nursing Home or long-term facilities from forcing
a third party to be a guarantor for the resident’s bills. Custodians
are only obligated to apply their loved one’s funds, not your own.
Medicare can pay for up to 100 days of custodial or home care, provided
a resident either is a) hospitalized for at least 3 nights, or b) needs
skilled nursing or skilled rehabilitation. Even if the facility nixes
the need for skilled nursing care, a resident can appeal.
Fees and Charges
42 CFR 483.10 (“Resident rights”) dictates that a facility’s
admission agreement should include all covered and “private pay”
(such as deodorant, soap, toothbrushes, etc.) charges.
Bed Holds During Hospital Stays
If your parent or relative is admitted for a hospital stay while a resident
at a nursing home, the facility must readmit them following their hospitalization
if they are eligible for Medicaid reimbursement and the facility has an
available bed. Although Medicaid and Medicare won’t pay for “bed
holds” in many states, private payment is allowed.
Nursing homes vary in the quality of care and services they provide to
their residents. Reviewing health inspection results, staffing data, and
quality measure data are three important ways to measure nursing home
quality. This information gives you a “snap shot” of the care
individual nursing homes give.