Jewish World Review Oct. 8, 2003 / 12 Tishrei, 5764
Jan L. Warner & Jan Collins
The home isn't implementing doctor's orders
http://www.NewsAndOpinion.com | Q: My elderly aunt was sent into a nursing home for rehabilitation after a two-week hospital stay for a severe stroke. After 10 days in the nursing home, she isn't receiving the services ordered by her physician. We told the staff about our concerns, but all we get is lip service. Meanwhile, my aunt is not getting any better. How can we move this along? Or should we try to get her into another nursing home? Her resources are limited.
A: Upon admission, the nursing facility should have completed a comprehensive assessment of your aunt by an interdisciplinary team, which includes the attending physician, a registered nurse who has responsibility for your aunt, and other staff chosen based upon your aunt's needs. Then, within seven days after the assessment, the facility should have developed and followed a comprehensive care plan for your aunt. This plan, which must be approved by the physician, should include not only objectives, but also deadlines for meeting the mental, psychosocial, nursing and medical needs of your aunt that were identified in the assessment. Your aunt, her family or a responsible person should have been included in this process.
Periodically, the facility should then review and revise the care plan after follow-up assessments, and your aunt should receive services that meet professional quality standards and are provided by qualified persons. A person who enters a facility should not get worse solely because he or she is in the facility. The facility must provide each resident with the correct services and treatment to improve or maintain that person's abilities. Your aunt's activities of daily living (ADLs) should not diminish unless this is an unavoidable result of her clinical condition.
While the state ombudsman's office might help, this could put the family and the facility at odds, which is not the best policy. Generally, when these types of issues arise, a geriatric care manager can help by reading the care plan and working with the facility. For more information, visit the National Association of Professional Geriatric Care Managers' Web site www.caremanager.org. Q: My mother ha
s lived in a nursing home for a year and has been in and out of the hospital. During some of this period, she was on private-pay status, the rest of the time on Medicaid. The nursing home is now telling us that they can't hold her bed while she is in the hospital. What are we supposed to do?
A: Before a nursing home can transfer a resident to a hospital, it is legally required to provide the resident, a family member or a responsible party with information that clearly specifies: (1) the state's bed-hold policy, if any, during which the resident is allowed to return and resume residence, and (2) the facility's policies regarding bed-hold periods that allow a resident to return.
Generally, if a person exceeds the time out of the facility that is specified in the policies, he or she must be readmitted to the facility immediately (if a bed exists) or when the first bed in a semi-private room is available. If you didn't receive these notices, because of the complexities involved, we suggest you contact an elder law attorney in your area. For more information, go to the Web site www.naela.org.
Q: After paying a nursing home more than $4,000 a month for the last 2-1/2 years, my mother ran out of money and we applied for Medicaid. The administrator told us that Mom would be moved out of her room into a "Medicaid Bed" in another part of the nursing home. Because she is doing well where she is, we believe a move would be detrimental to her condition. The nursing home insists this is necessary. What are our rights?
A: If a Medicaid-eligible resident occupies a bed that could otherwise be offered to a person who can pay privately, the nursing home will lose revenue because the costs funded by Medicaid are generally less than the amount the facility could generate from a private-pay patient.
Most nursing facilities separate residents based on level of care and source of pay, placing them on different floors or in different areas of the facility. Before the facility can transfer your mother, management must give notice of the pending transfer and the reason for it. This notice must include information about the resident's right to appeal and other important details, and generally must be given at least 30 days before the resident is transferred or discharged. In addition, the facility must give the resident sufficient preparation and orientation to allow for a safe and orderly transfer.
Although you'll probably be fighting a losing battle to contest the transfer (unless you have significant grounds), we suggest you seek the opinion of an elder law attorney in your area.
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JAN L. WARNER received his A.B. and J.D. degrees from the University of South Carolina and earned a Master of Legal Letters (L.L.M.) in Taxation from the Emory University School of Law in Atlanta, Georgia. He is a frequent lecturer at legal education and public information programs throughout the United States. His articles have been published in national and state legal publications. Jan Collins began co-authoring Flying SoloŽ in 1989. She has more than 27 years of experience as a journalist, writer, and editor. To comment or ask a question, please click here.
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