PART II: WHAT A NURSING HOME IS REQUIRED TO PROVIDE
By: William L. Bross
As mentioned in the previous installment, it is mandated that nursing home facilities abide by certain federal and state regulations and meet minimum requirements in order to receive funding. It is beyond the scope of this article to address each area, but some primary areas are discussed below
1) Staffing – each nursing home facility must have “adequate” numbers of nursing personnel, including licensed nurses (RN’s and LPN’s) and nursing assistants (CNA’s). Ask how many staff are present each shift and how many residents are under each of their care.
2) Individualized Care Plan – each resident in a nursing home facility is required to have his/her own care plan. This care plan is based on an assessment, by the licensed nurse and physician, of each resident’s overall physical and mental status and should be prepared to meet his/her needs. The initial care plan is established when the resident is admitted to the nursing home and should be complete and thorough. Every few months or as individual needs and conditions change the care plan must be reviewed by all persons who have given care to the resident. The resident, family members, and significant others should always be invited to attend meetings where the care plan is reviewed and they should be encouraged to assist in care activities when appropriate. Ask who is involved in your facility’s care planning.
3) Ongoing assessments of each resident – each resident must be assessed in some periodic manner by a licensed nurse or practitioner, much like when one is in a hospital. These assessments are critical to determine changes in one’s health status and determine whether given care is working to improve one’s condition or not. If not, it may be time to try some other treatment. Ask how often assessments are done and by whom.
4) Nutritional assessments – each resident should receive an initial visit by a dietician to assess their diet. Many residents in nursing homes have problems maintaining an ideal weight. Most frequently, many are underweight. This may be a significant problem when a resident also has problems with skin breakdown and infections. Dieticians may need to increase certain dietary requirements to ensure that each resident is in optimal condition. Find out how often a dietician will visit each resident. Make a visit to the dining room to see what it, and the food, is like.
5) Physician visits, orders and treatments – residents are to be visited by physicians on a periodic basis. They are to review all care plans, treatments and revise orders as needed. They are to be notified of possible changes in a resident’s condition in a timely manner. Find out how often the physician visits.
6) Proper care and treatment of bed sores, urinary tract infections and other medical conditions. Each nursing home facility should have a plan to address any of these conditions and many others as well. Each resident is entitled to optimal care to prevent further problems from developing.
7) A record-keeping system – each facility must maintain a record on each resident that accurately documents the clinical condition of, the treatment provided for and all consults rendered for each resident. This record should also show when each resident received medications, meals, baths, etc. Often, facilities that give the best care have the most well organized records. Be aware that the law provides that you are able to see your records within 24 hours of your request and must be made available for copying within 48 hours.
8) Quality assurance programs – each facility must have programs in place to look at problems as they arise, such as falls or infections, and make an effort to improve processes so the problems do not recur. Be sure that whenever a situation occurs with a resident you know that it is reported to the correct person, and follow-up with that person to see what was done to correct the problem.
A complete copy of the standards are found in the Requirements for States and Long-Term Care Facilities, 42 C.F.R. part 483; and the Omnibus Budget Reconciliation Act of 1987 (“OBRA”), popularly known as the Nursing Home Reform Act, 42 U.S.C. §13902-1395. The state standards that nursing homes must follow are the Rules of Alabama State Board of Health, Division of Licensure and Certification, Ala. Admin. Code chapter 420-5-10, and the Code of Alabama §22-21-20.
In the next installment we will examine some specific standards of care that frequently are of concern in nursing homes and what one should do if a problem results: Commonly Encountered Standards of Care and What You Should Look For on a Visit.