When a Loved One Needs a Nursing Facility – part 2

June 28, 2010
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When Visiting a Nursing Facility

Since some nursing facilities may have wait lists or unavailable beds, it is recommended that you try to broaden your search to at least 5 facilities. Before making any decisions, visit the facility. It is also recommended that you visit a facility a second or even a third time during weekend or evening hours when many nursing facilities reduce their staff. You can learn a great deal about a nursing facility by taking the time to sit and observe how staff interacts with residents.

If at all possible, take your loved one who will be residing in the facility with you. By doing so you can gain insight into the resident’s wishes and may ease his or her own fears.

Since there are so many questions to ask and many things to review, we recommend you go with a checklist. Attached to this memo is a Nursing Home Checklist created by the Department of Health and Human Services.

When a Loved One Enters a Nursing Facility

There are important things to know when your loved one enters a nursing facility. As a loved one, you play an important role in helping to advocate for your loved one’s best interests. It is therefore important to know your loved one’s rights in a nursing facility.

The Nursing Home Reform Amendments of OBRA 1987 require that nursing facilities “promote and protect the rights of each resident.” The resident’s rights must be displayed in the nursing facility along with a contact number for the state’s Long Term Care Ombudsman (a third-party resident advocate).

The general goals of this law are:

  • Quality of Life: The law requires nursing homes to “care for the residents in such a manner and in such an environment as will promote maintenance or enhancement of the quality of life of each resident.” A new emphasis is placed on dignity, choice and self-determination for nursing home residents;
  • Provision of Services and Activities: The law requires each nursing home to “provide services and activities to attain or maintain the highest practicable physical, mental and psychosocial well-being of each resident in accordance with a written plan of care which is initially prepared, with participation to the extent practicable of the resident or the resident’s legal representative;
  • Participation in Facility Administration: The law makes “resident and advocate participation” a criteria for assessing a facility’s compliance with administration requirements;
  • Assuring Access to the Ombudsman Program: The law grants immediate access by the Ombudsmen to residents and reasonable access, in accordance with state law, by Ombudsmen to records; requires facilities to inform residents how to contact Ombudsmen to voice complaints or in the event of a transfer or discharge from the facility; requires state agencies to share inspection results with Ombudsmen.

It is equally important to stay involved in your loves one’s care:

    1. Be familiar with staff members. Get to know their names, roles and responsibilities in resident care. Know who is in charge of your loved one’s care and how various grievances are addressed.
    2. Educate the facility staff about your loved one’s preferences, daily routine, activities, work, etc.
    3. Pay attention to the care provided. Note any changes and try to determine if they are due to any deficiencies in the care provided.
    4. Report concerns and problems to staff members as soon as they arise so they can be addressed immediately. First voice concerns to those directly involved. If the action yields no results, report your concerns to staff supervisors.
    5. Document your concerns and the actions taken to report them. Be sure to include the names of those involved, the date, time, and details of the event.
    6. Request a meeting with appropriate staff involved in your loved one’s care. Focus the meeting on the outcome you would like to see and how it can be accomplished. The meeting should result in a concrete plan that addresses the problems and identifies who is responsible for implementing them.

What You Can Expect From the Facility

All nursing facility residents must have a comprehensive assessment within 14 days of admission to a nursing facility. The goal of the assessment is to evaluate your loved one’s physical and mental condition including their ability to perform activities of daily living (ADLs) such as eating, walking, dressing, and bathing. Their personal preferences and habits should also be discussed. Within 7 days of the initial assessment, the facility must hold a Care Plan Conference. At this conference, an individualized Care Plan is developed for the resident by an interdisciplinary team including a nurse, nurse aide, activities director, dietary staff, and social worker. It is very important that the resident and family members actively participate in this initial assessment and the Care Plan conference to ensure that all of the resident’s needs are addressed.

The Care Plan specifically outlines how individual staff will assist the resident on a daily basis to ensure they maintain the highest physical, mental and social functioning.

Every 90 days after the initial Care Plan is developed, or whenever there is a significant change in the resident’s condition, another Care Plan Conference is held to determine what changes need to be made to the Care Plan.

Resources Available to Nursing Facility Residents and their Families

A Long-Term Care Ombudsman is an advocate for residents of nursing homes, board and care homes and assisted living facilities. Ombudsmen provide information about how to find a facility and what to do to get quality care. They are trained to resolve problems. If you want, the Ombudsman can assist you with complaints. However, unless you give the Ombudsman permission to share your concerns, these matters are kept confidential. Under the Federal Older Americans Act, every state is required to have an Ombudsman Program that addresses complaints and advocates for improvements in the long-term care system.

To find an Ombudsman in your community you can contact http://www.ltcombudsman.ny.gov or call 1-800 342-9871.

Join the Family Council in the Nursing Facility. The Family Council in a nursing home is a consumer group composed of friends and relatives of the home’s residents. Although each family council is unique, a typical council has 5-10 active members; meets monthly at the nursing home; is run by relatives and friends or residents; has an advisor (usually a staff person at the nursing home) who assists the Council but is not a member; and has a variety of activities.

The main purposes for having a Family Council are: (a) to protect and improve the quality of life in the home and within the long-term care system as a whole, and (b) to give families a voice in decisions that affect them and their resident loved ones. Beyond these general goals, specific purposes exist, such as support for families; education and information; services and activities for residents; joint activities for families and residents; action on concerns and complaints; and legislative action, among others.

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