In 1987 congress enacted the Nursing Home Reform Act to promote and protect the rights of residents. But a new study by the federal government says one in five nursing homes still has deficiencies severe enough to harm or endanger residents. Today contributor and consumer attorney Alan Kopit gives advice on how understand the legal issues involved in nursing home care.
ALTHOUGH NURSING HOME care has improved in recent years, one in five still has deficiencies severe enough to harm or endanger residents. In a recent survey conducted by the General Accounting Office, it was found that serious problems existed at 3,500 of the nation’s approximately 17,000 nursing homes. Recognizing the need to improve the lives of nursing home residents, more than 15 years ago Congress enacted a law requiring nursing homes to promote and protect important rights of each resident, while embracing their individual dignity and self-determination. This article will help you understand those rights.
LAW MAKES A NURSING HOMES
The Nursing Home Reform Act requires nursing homes to promote and protect the rights of each resident. A strong emphasis is placed on individual dignity, choice, and self-determination. Nursing homes must meet these requirements in order to participate in Medicare or Medicaid. These requirements have clearly led to an improvement of conditions at most nursing homes.
Today each nursing home is required to provide services and activities to attain or maintain the highest practicable physical, mental, and social well-being of each resident in accordance with a written plan of care. This plan of care is initially prepared with participation of the resident (if possible), the resident’s family, or his or her legal representatives. The goal is that the well-being of a resident will not decline as a direct result of the nursing facility’s care. To give good care, staff must assess and plan care to support each resident’s life-long patterns, current interest, strengths and needs.
To develop such a plan, care planning conferences are held at the inception of residency. These conferences are a valuable forum for residents and families to voice concerns, ask questions, give suggestions, learn nursing home strategies, and give staff information (such as the resident’s background, daily routines and medical history).
RECOGNIZING A PROBLEM
All nursing home residents are entitled to live in an environment free from neglect, abuse, and misappropriation of property and funds.
Neglect is the failure to care for a person in a manner which would avoid harm and pain, or the failure to react to a situation which may be harmful. Neglect may or may not be intentional. If you see a nursing home patient who appears to be unclean, has bruises, looks as though he or she is malnourished or dehydrated, these may be signs of neglect.
Abuse means intentionally causing pain or harm. These acts can include physical, mental, verbal, psychological and sexual abuse, corporal punishment, unreasonable seclusion and intimidation. Bruises on the body or a sudden change in the emotional well-being of a resident may be signs of abuse.
Misappropriation of property and funds is a deliberate misplacement or misuse of a resident’s belongings or money without the resident’s consent. If a resident suddenly says that he or she can’t find jewelry or has lost bank account information, this could be a sign of misappropriation of property or funds.
In all of these cases, you should investigate the problem immediately by contacting a staff member. Then you should follow the procedure established by the nursing home for the investigation of any problems you suspect are occurring.
CHOOSE A NURSING HOME WISELY
First and foremost, the alternatives must be examined. Some elderly people may be better off in their own homes and may be able to function quite adequately with minimal assistance. Still others may be able to move to an assisted living facility, which gives them more independence than they might have in a nursing home. If a nursing home is required, determine which qualities of a nursing home are most important for meeting the needs and expectations of the resident.
Consider the following issues when evaluating nursing homes:
Bed availability (is there a waiting list to be admitted or can one be admitted immediately?)
Provision of services that the resident will need (are there special needs of concern to this resident?)
Affordability (can one meet the monthly rent and for how long?)
Quality of the facility (what do you know about the living conditions at the nursing home?)
Location (is the home located somewhere that is convenient for you or a loved one to visit often?)
Some quality issues are subject to personal preferences while others are critical to any resident’s health and well-being. Ask nursing home residents, residents’ families, citizen advocacy groups, your physician, and clergy members for their opinions about various facilities.
GUARANTEED RIGHTS TO NURSING HOME RESIDENTS
The rights of nursing home residents, guaranteed by federal law, fall into the following categories:
The right to information
A nursing home resident has a right to be informed of all services available as well as the charge for each service. They have a right to be informed of rules and regulations governing the facility, and the right to be notified in advance of any plans that may be changed that will affect their care. In addition, they have a right to daily communication in their language, and a right to assistance if they are sensory impaired in any way.
The right to participate in their own care
A nursing home resident has a right to receive adequate and appropriate care that they have helped to design. They have a right to receive appropriate care taking into account their medical condition, and they have a right to refuse medication or treatment. Finally, they have the right to make independent choices, such as what to wear and how to spend their free time.
The Right to Privacy. A nursing home resident has the right to privacy and confidentiality in all of their affairs, and an unrestricted right to communicate with any person of their choice, including their family, friends, clergy, or physician.
The right to manage personal financial affairs
Every nursing home resident has the right to manage his or her own financial affairs. In addition, a resident has the right to be free from charges for services covered by Medicaid or Medicare.
The right to dignity, respect, and freedom
Each nursing home resident has the right to be treated with the fullest measure of consideration, respect, and dignity. They have the right to be free from mental and physical abuse, corporal punishment, involuntary seclusion and physical and chemical restraints. Finally, and perhaps most important, they have the right to self-determination.
WHERE TO GO FOR MORE HELP
There are many fine organizations willing to help nursing home residents;
The National Citizens’ Coalition for Nursing Home Reform: 1424 16th Street, NW, Suite 202, Washington, D.C. 20036-2211. Phone: (202) 232-2275; website: www.nccnhr.org.
AARP: 601 E Street NW, Washington, D.C. 20049; phone: 1-800-424-3410; website: www.aarp.org
Centers for Medicare and Medicaid Services: 7500 Security Boulevard, Baltimore, Maryland 21244-1850; phone: 1-877-267-2323 website: http://cms.hhs.gov
Alan Kopit is a consumer attorney with the firm Hahn Loeser and Parks LLP in Cleveland, Ohio and a regular contributor to “Today.”