I would like to share a simply EXCELLENT guide for good care in a nursing home. It is “20 Common Nursing Home Problems – and How To Resolve Them” by one of the nations’s premiere legal advocates for nursing home residents, Eric Carlson. It is free and available through http://www.justiceinaging.org/.
Being a lawyer I cannot give a blanket recommendation but must, as does the 20 Common Guide, advise you to use your judgment and seek professional counsel if the Guide seems to steer you on a dangerous or futile path. The Guide is only a guide. You must use your judgment.
Here are my comment on some on some of the points.
Some few points envision an ideal nursing home
Number 3 says the nursing home must accommodate a resident’s preferences and gives an example of everybody being awakened at 6 a.m. The explanation offered is inadequate staffing. So, If the resident does not want to be gotten out of bed at 6 a.m. the patient advocate may find the resident still in bed hours later because the aides are now taking care of other patients. The Guide suggests the patient advocate come up with an alternate plan for “sleeping in” and getting dressed and breakfast after other residents.
Number 4 points out that the law says each nursing home must provide care to enable the resident to reach “the highest practicable level of functioning.” Most patient advocates would find these words are other worldly goals that may not be met on this earth. Under-staffing is a chronic problem in nursing homes.
You must use your judgment on patient care
Number 5 deals with improper use of physical restraints and notes their use has decreased dramatically in the past decades. Everybody agrees that is good. And I have observed that it seems like all nursing home residents are put in wheel chairs. Could some walk with walkers? Are they in wheelchairs because they are easier to manage and there is less fall risk? The answers depend on the particular case. However, I must add falls are extremely dangerous for the sick elderly. They can lead to death through complications from surgery or hospital stays.
Number 5 gives bed rails as an example of a physical restraint. These rails prevent residents from falling out of bed. The Guide suggest that a bed can be lowered to the floor and a pad on the floor. This will take care of falls out of the bed. But they do not address the problem of the resident who gets out of bed and then falls when trying to walk.
Some seem out of date.
Number 11 cites refusal to bill Medicare. Medicare has changed. Gone are the days when the patient’s doctor wrote a prescription and it was followed. Now Medicare controls the provider. The doctor does not. The provider must be able to put every service into a proper billing code while fearing charges of Medicare fraud if the billing is denied. Patients are offered a “rubber stamp” appeal system where KPRO, the Medicare “QIO,” denies almost all appeals. Billing Medicare does not produce the results it used to just 10 years ago.
Some address non-problems.
Number 8 says a nursing home may not impose visiting hours. I have not heard from clients that nursing homes had visiting hours.
Number 17 says the nursing home may not charge residents extra for medical care. In today’s medical environment the issue of co-pays and deductibles, prescription formularies and limitations on coverage is well known. If an item is not paid it is usually a matter of insurance.
Number 18 says the nursing home must support resident and family councils. This may have been a big issue when nursing homes were homes for the frail elderly. Now these residents are in assisted lving apartments, not nursing homes. The nursing homes are taking care of a much sicker population now.
Some guide the resident into futile battles
Number 14 offers very useful advice about dealing with the problem of the alleged “short term stay” facility explanation. That is, after post-hospital skilled care ends, e.g. rehab, the nursing home tells the resident they have to move because they are now “long term care.” That is untrue because all “nursing homes” are long term care facilities by virtue of their licensing.
However, the Guide sends a patient advocate into futile court battles when it advises that a nursing home can get a bed certified by Medicaid for the resident. Michigan restricts the number of Medicaid beds it approves. One local attorney took a well financed nursing home to court on the issue and lost.
Number 20 advises that a resident may refuse medical treatment. It is all to often true that the guide for medication in a nursing home is administrative convenience. However, the patient advocate may find it impossible to be consulted on each medication change before it happens. Some have waited all day to see a doctor to explain a change, only to have the nursing home doctor never show up.
Nevertheless, a patient advocate must advocate for good care and sometimes that means moving the resident out of a sub-standard nursing home.
In closing,
Believe me, the above comments do not take away the immense value the Guide offers to Patient Advocates. If you have somebody in a nursing home, get it now. You will not regret it and you will find you will be sharing it as am I.
