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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:

• Care Plans 
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.

• Visiting Hours
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 expecting visitors.

• 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.

• Forcible Restraints
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.

• Home Care
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.


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