Solving Nursing Home Problems
Understanding how the home system works, how to solve problems, where to go for help, and the residents' rights are important in getting good care in a nursing home.
Communication Is Key
There are many reasons why nursing home care is not always good. At the first sign of a problem, it is best to discuss it with the nursing home staff. Friendly, open communication and relationships with nursing assistants, charge nurses, the director of nursing, the social workers, the administrator and other staff help keep small problems from becoming big. When a problem comes up or is ongoing, chances are that other families (and residents) are also concerned.
Communication among the families of residents is so important that Medicare and Medicaid nursing homes are required to allow families to form family councils. These councils can meet privately in the facility. Ideally, the council is a place for families to talk freely among themselves. They can present concerns or complaints to staff. Find out if there is an established family council already meeting. If not, start one. Communication is always the best step to avoiding or solving problems.
Periodically, nursing homes must hold care planning meetings. During these, residents' needs and any changes the nursing home should make in their care are discussed. It's important that residents and their families participate in these meetings. The meeting should involve a team of staff members, not just nurses. Ask about the next care planning conference. Ask who will be attending and feel free to request that other staff attend as well (including nursing assistants). The long-term care ombudsman, a member of the clergy or a close friend could also come to the meeting to provide support.
How to Solve Problems
Often families fear that if they complain, someone will take it out on their loved one. Sometimes, out of fear, residents ask family members not to speak up. This is the primary reason families hesitate to complain about poor nursing home care. Nursing home workers themselves say that families who call attention to problems get results. Try the following suggestions to confront problems:
- Use the care planning conference to discuss problems with staff. This meeting creates a natural setting to address concerns without raising them to the level of a complaint.
- When making a complaint about a staff member to a supervisor, share any concerns about retaliation.
- Work with the family council to address problems in the nursing home.
- Solving problems can be more affective when working in a group.
If the nursing home is poorly staffed or poorly managed, it may not give good care until residents or their families take the concern to a higher level. If working with the nursing home is not getting the problem solved, never hesitate to take a complaint outside the facility The purpose of your complaint should be to get better care for a loved one and the other residents. It should not be to hurt the facility or its employees. A written record can be very helpful when filing a complaint. Keep track of when the problems(s) occurred and who was involved. These are some places to go for advice or investigation of complaints dealing with nursing homes:
- Long-term care ombudsman
- Citizen advocacy groups
- Legal services
- State licensing and certification agency
When the Nursing Home System Fails
If nothing you try improves the care a loved one is receiving, join a citizen advocacy group. If none exists, form one. Ask the family council group for help, and check with the local AAA or ombudsman program about how to get an advocacy group started in your area.
Protecting Rights and Dignity
Too often people lose even the simplest rights when they become nursing home residents:
- Privacy when they sleep, bathe, and dress
- Freedom to go wherever and whenever they want to visit with friends and relatives
- Choice of what they eat or wear
- Control of their money
- The right to choose their own doctor or make decisions about medical treatment
The Nursing Home Residents' Bill of Rights helps people keep their privacy and dignity. It protects rights as basic as whether or not staff knocks on the door before entering a resident's room. These rights apply to all residents who live in Medicare or Medicaid certified nursing homes.
Neglect and Abuse
Good care is everyone's basic right in a nursing home. Poor care is usually from the nursing homes' failure to have enough qualified licensed nurses and nursing assistants. It is understandable to sympathize with overworked nursing staff, but expectations for good care should not be lowered. Nursing homes must keep an adequate number of qualified staff.
Providing poor quality food, not keeping residents clean and dry, and ignoring a change in a resident's condition, are all signs of neglect. Sometimes poor care and neglect may result in dangerous medical conditions. Some signs to watch for are:
- Dehydration
- Malnutrition
- Bedsores (or pressure sores)
- Physical restraints
- Chemical restraints (Drugs used to control a resident ' s behavior)
- Contractures (Muscles that are becoming too stiff to move easily)
Abuse sometimes happens in nursing homes. Sometimes residents are hurt physically or psychologically. Do not accept behavior toward a loved one that is abusive, including rough treatment or unkind words during or in between care. If supervisory staff do not act immediately to fix a problem, contact one or more of the following authorities:
- The long-term care ombudsman
- The local adult protective services agency
- The police
Nursing homes should be a place where loved ones get the care they need. Working together, families can make nursing homes better.
Information provided by http://www.aarp.org/
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Health advocates are calling for tough new rules on the use of anti-psychotic drugs in Illinois nursing homes, including tighter controls on doctors who prescribe the powerful medications.
An investigation by Tribune and ProPublica showed many frail and vulnerable Illinois nursing home residents have been unnecessarily dosed with anti-psychotics, leading to harm and an increased risk of death. One psychiatrist provided assembly-line care to thousands of mentally ill patients.
The FDA has approved anti-psychotic drugs to treat serious mental illnesses, such as schizophrenia, but doctors may also prescribe them to geriatric patients with other conditions, such as dementia, in a common but controversial practice called "off-label" use.
Wendy Meltzer of Illinois Citizens for Better Care, an advocacy group for nursing home residents, suggest one way to stop nursing home doctors from using the drugs to "chemically restrain" residents is for the state to refuse to pay for certain medications.
Meltzer also stated that the state should not pay for multiple antipsychotics for the same residents or for psychotropics at dosages over the recommended limits without prior approval.
Documents show that hundreds of nursing residents have been given psychotropics without their permission since 2001. Meltzer suggest nursing homes use standardized consent forms for each psychotropic drug.
Investigation of Chicago psychiatrist Dr. Michael Reinstein revealed yet other issues. Although Illinois law requires psychiatric hospitals to report patient deaths, three deaths of people under Reinstein's care were never reported. Although the Department of Public Health grants and revokes the licenses of psychiatric hospitals, it cannot levy penalties for lax death reporting because that law is on another agency's books. Advocates said inconsistencies like this should be fixed.
Advocates are also asking Illinois lawmakers to require drugmakers to publicly disclose payments to doctors so that their patients can be aware of possible conflicts of interest. The investigation showed that one pharmaceutical company gave Reinstein nearly $500,000 to promote a drug that Medicaid records suggest he prescribed 41,000 times. Reinstein has disputed those figures.
State Rep. Jack Franks, D-Marengo, has pushed a bill since 2005 requiring drugmakers to report the amount of money and gifts they give to doctors, nursing homes and hospitals. The bill has not passed, but he said he plans to re-introduce it next session.
www.chicagotribune.com/health/chi-psychotropics-reformdec20,0,3977364.story
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Deregulating public oversight of nursing facilities and relying on voluntary quality improvement programs have been a priority for the nursing home industry for many years. Surprise, surprise, this year is no different. In a secret Issue Brief[1] being circulated on Capitol Hill, but not included with other Issue Briefs on its website, the American Health Care Association (AHCA), the trade association of for-profit nursing facilities, is asking Congress to repeal the current statutory requirement for annual surveys of nursing facilities and to go back to less-than-annual surveys, undermining years of work toward greater facility accountability. Which is exactly what we need, giving people who take care of our loved ones less accountability for their actions or inactions in the care of their patients, please note the sarcasm!
The Secret Proposal
In proposed revisions to the survey and enforcement provisions of the Nursing Home Reform Law enacted by Congress in 1987, AHCA asks that nursing facilities in the "Top Tier" have on-site surveys only every three years, at statewide intervals not exceeding 39 months. [See AHCA, "Proposed Legislation; Nursing Home Survey Reform" (Issue Brief, undated).] AHCA does not define "Top Tier" facilities, does not describe how they would be selected, and does not identify how many facilities would avoid annual surveys under its proposal. Top Tier facilities would have "quarterly off-site reviews of acuity adjusted quality indicators" and, in the years when they did not have surveys, "a half day on-site review of quality of life and safety issues." No details are provided.
AHCA's secret legislative proposal also excludes, and may be intended to delete, long-standing statutory language that authorizes the imposition of various intermediate sanctions against facilities that fail to provide residents with the care and services they need. The proposal deletes enforcement requirements such as the statutory mandate that more serious remedies be imposed for uncorrected or repeated deficiencies.
Back to the Future
AHCA's legislative proposal revives the Reagan Administration's 1982 proposal to conduct nursing home surveys on a less-than-annual basis.[2] It was this change, among others, that led to two Congressionally-enacted moratoria preventing deregulation of the nursing home industry, the Institute of Medicine's 1986 study of nursing homes, Improving the Quality of Care in Nursing Homes, and, ultimately, enactment of the 1987 Nursing Home Reform Law.[3] Since 1987, Congress has required that all nursing facilities have annual standard surveys, conducted on a 9- to 15-month cycle, with a statewide average of 12 months.[4]
AHCA's Proposal Lacks Merit
In support of its proposal, AHCA first argues that "a one size fits all approach" to surveys "fails to provide incentives and disincentives to encourage better performance by nursing homes." This argument ignores the fact that current law already mandates a flexible survey cycle, allowing less frequent surveys in facilities with fewer problems. The incentives that AHCA calls for to encourage better facility performance are already in place.
Next, AHCA argues that "variation within the survey process makes it extremely difficult to provide information that would allow for meaningful comparisons of individual homes within and across states." Yet current Federal law requires that surveyors use a uniform survey process throughout the country for all facilities participating in Medicare or Medicaid or both. AHCA fails to explain how, if its members are concerned with variation in the use of the uniform survey process, having different survey processes for "Top Tier" facilities and other facilities would make "meaningful comparisons" among facilities more likely. Rather, the exact opposite seems true; different survey processes would make "meaningful comparisons" less possible.
AHCA's argument concludes, "When all of this is considered in the context of a confluence of shrinking resources, increased availability of quality data and a public demand for more useful, timely and reliable data, there is the opportunity to streamline and improve the current survey system."
Shrinking survey resources are indeed a problem. The Government Accountability Office recently reported that the portion of the Medicare budget spent on quality assurance declined from 0.1% in fiscal year 2000 to 0.06% in fiscal year 2008[5] and that some categories of health care providers are surveyed only once every 10 years.[6] State survey agencies contend that no health care provider should go more than two or three years without a public survey. Restoring and substantially increasing survey budgets should be a priority for the federal government.
AHCA's reference to the availability of "quality data" is presumably a reference to the quality measures, which are self-reported information about residents, taken from residents' assessments. These measures were originally developed to help surveyors focus on problems that were likely to be found in a facility, not to indicate whether residents were receiving high quality of care. Although the industry uses these quality measures as a proxy for actual quality of care in its voluntary campaign, Advancing Excellence in America's Nursing Homes,[7] these self-reported measures are not a reliable substitute for an independent, on-site, and public evaluation of actual facility performance.
Additional proposals by AHCA require that surveyors "include all the positive aspects of care and facility life as well as the aspects of care that are performed less well" and rename the Statement of Deficiencies to "Report of Survey." AHCA proposes that the Department of Health and Human Services focus more attention on survey consistency. While consistency is important and has been required by the Reform Law for decades, accuracy is also important. A facility should not be allowed to challenge a deficiency simply because the facility next-door was not also cited for the same problem.
Conclusion
AHCA's proposals do not "streamline and improve" the survey and enforcement processes; they destroy them. Congress should reject industry proposals to deregulate the nursing home industry.
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The new rule designates state inspectors and Medicare and Medicaid contractors as Federal employees. Federal employees are usually shielded from providing evidence for either side in private litigation. This new restriction will affect abou 16,000 nursing facilities and 3 million residents in the US.
The Practical effect of this rule is to force attorneys to go to greater lengths to get inspection reports or depositions for cases. "This Change hurts nursing-home residents and their families by allowing bad practices to be kept in secret by nursing homes and inspectors," said Eric M. Carlson, an attorney with the National Senior Citizens Law Center in Los Angeles. "Government inspectors have the right to go into nursing homes and investigate. and they learn things that residents and families otherwise could never find out."
The new rule generally prohibits state health departments and contractors from participating in pricate lawsuits involving facilities that are in the federal assistance program without approval by the head of the Department of Health and Human Services.
Once fairly routine, the request for information is now stalled between federal and state officials.
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Sarah Wentworth, 89, was too frail to get out of bed or change her clothes without assistance, yet she died alone in the courtyard of her nursing homes' below freezing temperatures on Feb. 5th. She was found wearing only her hospital gown and her ankle bracelet that should have triggered an alarm when she went through an exit door. Wentworth was outside in the freezing temperatures for at least 90 minutes before being found, authorities say.
Sarah Wentworth had lived in the Arbor of Itasca nursing home for two years prior to the Feb. 5th, incident, her daughters said that they never had been concerned about their mother's safety at the nursing home up to this point. They were surprised to learn that since the beginning of 2008, the Department of Public Health in Illinois had conducted 12 separate investigations on the facility in response to complaints.
What do you know about your loved ones care facility? How up to date are you on what's going on with your loved one? Nursing home malpractice is a significant problem throughout the United States. Comprehensive government investigations have discovered that approximately thirty percent of all nursing homes in the nation have committed intentional or negligent acts which have caused significant harm to nursing home residents. One study of nursing home resident death certificates listed more than 4000 deaths caused by dehydration, malnutrition, and bedsores; all of which are caused, in whole or part, by nursing home malpractice. In 2003 USA Today reported that half of all nursing home residents suffer from untreated pain.
In response to these atrocities, the federal government has attempted to regulate the nursing home industry. In 1987 the Federal Nursing Home Care Reform Act was passed, setting a set of minimum standards of care and quality of life that nursing home facilities must meet or exceed. The primary objective of this law is to ensure that facilities provide services that facilitate, "the highest practicable physical, mental, and psychosocial well-being for each resident." State agencies conduct periodic investigations of nursing home facilities, order corrective action and pursue cases of abuse and neglect when applicable.
State agencies have also been established to investigate complaints of abuse in nursing homes. These can be complaints made by, or on behalf of, nursing home residents. These complaints can be about any deficiency in required nursing home services or may involve cases of obvious abuse. The government can investigate these cases and has the authority to issue a citation, impose a fine, and/or require corrective action.
In cases of nursing home malpractice, a nursing home lawsuit may alsobe filed by the victim of the abuse. A nursing home lawsuit is the vehicle through which a victim is personally compensated for his/her losses. The most common type of nursing home lawsuit is one that involves abuse, neglect, or wrongful death. A wrongful death nursing home lawsuit can be filed by the family and/or beneficiaries of a nursing home resident who has died as a result of nursing home malpractice.
It is important to keep in mind that each state has a statute of limitations which restricts the amount of time a person has to file a nursing home lawsuit. Retaining the services of a qualified and experienced legal professional is a crucial aspect to filing a nursing home lawsuit. An attorney can evaluate the facts of your case to determine your legal rights and options in a nursing home lawsuit. This legal professional knows the laws applicable to your case and can protect and maximize your interests.
Information for this blog taken from the Chicago Tribune Times and http://www.nursing-home-abuse-resource.com/.
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Medicare has recently unveiled a program to give nursing homes a ranking system based upon a five-star level of ratings. The determining factors include staffing and the results of state inspections.
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