Question: My mother was admitted to a nursing home after ten days in the hospital. Although she has been there for a week, we don’t think she is getting the services that were ordered by her doctor. We have not been able to get anyone’s attention, and Mom is not getting any better. What can we do?
Answer: A person who enters a facility should not get worse just because he or she is in a nursing home. Yet, at the same time, as a concerned family member, you may be expecting too much too soon. Federal law requires that facilities provide the services and care necessary for each resident to reach and maintain the best mental, psychosocial and physical well being possible. Upon admission, each resident receives a comprehensive assessment from an interdisciplinary team of professionals that includes the attending physician, a registered nurse responsible for the resident’s care, and other staff personnel who are chosen based upon the resident’s needs. Then, within seven days, the facility must develop and implement a comprehensive care plan for that resident. This plan must include not only objectives, but also deadlines for meeting the identified mental, psychosocial, nursing and medical needs of the resident. To the extent possible, your mother, her family, or responsible person should be included in this process.
In addition, the facility must review and revise its plan after each assessment, and all services provided must meet professional quality standards in order to make sure that the resident's activities of daily living (ADL’s) do not diminish -- unless as a result of the resident's clinical condition that can’t be avoided. While you want to assure the best care possible for your mother, you want to try to resolve issues such as this without third party intervention. We suggest that your first step should be to set a meeting with the administrator of the facility so you can voice your concerns. If you are still not satisfied, you may wish to contact your state ombudsman’s office. In order to avoid confusion and confrontations, we recommend that private geriatric care managers become involved in discharge and admissions process.
Question: My father has been in a nursing home for a past year during which he was in and out of the hospital. Until his money ran out, he was on private pay, and now is on Medicaid. The nursing home is now telling us that that they can’t hold his bed while he is in the hospital. What are we supposed to do?
Answer: Since your father is a Medicaid patient, the nursing home is required by law to provide him, a family member, or a responsible party with information that clearly specifies 1) the bed-hold policy under the plan of that State, if any, during which the resident is allowed to return and resume residence, and (2) the facility’s policies regarding bed-hold periods which allow a resident to return. Each nursing facility is required by law to establish and follow written policies dealing with bed-hold and what happens if the resident’s absence from the facility exceeds the bed-hold period under the State plan. Generally speaking, that person must be readmitted to the facility immediately (if a bed exists) or at the time the first bed in a semi-private room is available. If you did not receive these notices, because of the complexities involved, we suggest you contact an elder law attorney in your area.
