PART III: COMMONLY ENCOUNTERED STANDARDS OF CARE AND WHAT YOU SHOULD LOOK FOR ON A VISIT
By: William L. Bross
As mentioned in the previous installment, there area certain standards of care that are of concern in nursing homes especially. Upon selecting a nursing home it is important to realize that “a facility must be administered in a manner that enables it to use its resources to effectively and efficiently attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident.” 42 C.F.R. § 483.75. Also be aware that each facility must have certain staff members. These members include: a medical director, a registered nurse to be the full-time Director of Nursing, and licensed nurses (that include at a minimum one registered nurse on the premises for at least 8 consecutive hours a day, 7 days a week).
While accidents do happen, nursing homes hold themselves out as facilities that can prevent or minimize accidents or hazards. The regulations provide specific standards of care in various areas of nursing care for conditions that occur with regularity in nursing home residents. Some of these conditions include:
a) pressure sores – a resident who enters the facility without pressure sores does not develop pressure sores unless they are clinically unavoidable; and a resident with pressure sores receives necessary treatment and services to promote healing, prevent infection and prevent new sores from developing;
b) falls and fractures – a facility has a duty to prevent falls and fractures by ensuring that the resident environment remains as free of accident hazards as possible, and ensuring that each resident receives adequate supervision and assistance devices to prevent accidents;
c) dehydration, malnutrition, choking – based on the residents comprehensive assessment, the facility must ensure that a resident “maintains acceptable parameters of nutritional status, such as body weight and protein levels unless clinically not possible. The facility must also provide each resident with sufficient fluid intake to maintain proper hydration and health;
d) misuse of chemical and/or physical restraints – a resident has the right to be free from any physical or chemical restraints imposed for purposes of discipline or convenience, and not required to treat the residents medical symptoms.
These are just several examples of the numerous standards of care set out by the regulations promulgated by the federal and state government. However, many times nursing homes fail to abide by one or more of the standards set out by the various rules and regulations. Many of the complaints and violations that are preventable that we are reading about more frequently in the media are major bed sores (decubitus ulcers); severe dehydration; falls resulting in fractures; “wander-off”cases, where individuals suffer serious injury or death after wandering from the nursing home; physical abuse; rape and/or sexual assault. If an unusual occurrence ever happens to an individual you know that resides in a nursing home be sure to notify the administrator of the facility immediately. This will allow them to notify the proper government agencies to allow for a full investigation of the particular incident and the facility in general. Thereafter, contact the state long-term care ombudsman, through the Alabama Department of Senior Services at 1-877-425-2243, and the Elder Care Hotline of the Alabama Department of Public Health, at 1-800-356-9596.
It is important to visit the nursing homes that you are considering for yourself or for a loved one. When there, have questions prepared to ask the representative you visit with. When touring the facility, take time to observe how the staff interacts with the residents. If you can, ask some of the residents about how they like living there. What activities do they enjoy? Be sure to look around closely: Does it look clean? It is calm or chaotic? Do the residents look happy? Do they interact with one another? If you or your loved one have special needs, be sure to inquire as to whether or not the nursing home has experience in these areas. Visit the dining room and see what the residents have for a meal. Better yet, try one yourself. After this first planned visit, go back again. Select another time of day such as the evening or on a weekend when the staff persons present will usually be fewer. Does it look like the needs of the residents are being met then?
If you are planning on placing a loved one in a nursing home, take that person with you for a visit if possible. Be sure to listen to that person’s concerns and fears. Be sure that you inquire about financial provisions. Be sure to choose a facility that accepts Medicaid because persons typically run out of money after entering a nursing home and end up on Medicaid.
These are just a few of the issues that you should explore carefully when selecting a nursing home. In our final installment, we will examine other sources that you should use to gather information when selecting a nursing home: Sources Available to Assist in Selecting a Nursing Home.