Advocating for Nursing Home Care
By Jill Burzynski
We often work with families of patients in nursing homes and the families often are misinformed about what must be provided by the facility. Sometimes we have heard from family members that the facility is requiring the family to hire a private-duty aide to ensure the safety of the resident. However, Section 483.25 of Title 42 of the Code of Federal Regulations provides that the nursing home must provide the care that a resident needs to reach the highest level of functioning. The nursing home is not meeting this requirement if they are requiring the family to hire private duty aides. If the facility asks the family to provide a private caregiver, the family needs to make clear that it is the nursing home’s legal responsibility to provide necessary care and that a claimed shortage of staff or money is no excuse. If the issue continues to be a problem, the family can consider seeking assistance from the ombudsman program ( 1-888-831-0404 (toll-free) or 1-850-414-2323). A long-term care ombudsman is a volunteer who helps to improve the lives of people who live in long-term care settings like nursing homes, assisted living facilities and adult family care homes. Families should be vigilant to ensure that the facilities are providing the care that they are legally required to provide. We often encourage families to hire or provide additional services that augment the quality of life that a patient will have while in a facility. However, it is important that these added services augment and supplant the care that the facility must provide.
Families should also be vocal when they believe that the resident would benefit from physical or occupational therapy, even when the Medicare payment has been discontinued. Sometimes families believe that these services are only available to the patients on Medicare. However, Appendix PP to the State Operations Manual of the Centers for Medicare and Medicaid Services makes it clear that therapy services should be provided even if the nursing home is entitled to no more than the Medicaid rate. Therapy ordered by the doctor must be provided regardless of the patient’s payment source. If the doctor can be convinced to order the therapy, then the facility must provide it. The families need to develop a close relationship with the treating physician and be sure that the treating physician is aware of all of the needs of the patient.
Many families receive incorrect information about long term care. It is important that families with loved ones in nursing homes become informed about applicable laws to ensure proper care.
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