There is an old saying that knowledge is power. The more information you have about a topic, the better educated you are, and the better able you are to deal with issues that may arise. Placing a loved in a nursing home is a difficult undertaking. Nursing homes are inspected and regulated by both state and federal officials. In 1987, Congress saw the need to increase the oversight of nursing homes. As a result, it passed the Omnibus Budget Reconciliation Act of 1987. This act is commonly referred to as the Nursing Home Reform Act.
This Act requires that nursing home facilities that receive Medicare and Medicaid “must provide services and activities to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident in accordance with a written plan of care.” Individual states may, and in some cases do, impose even greater standards on nursing homes than those imposed by this federal Act.
The requirements that must be met by nursing homes are promulgated at 42 CFR Part 483. There are numerous regulations, but some of them are more significant than others. These would include:
• Develop a comprehensive care plan for each patient. (42 CFR § 483.20.) Once a person is admitted to a nursing home, a comprehensive care plan is to be performed by the appropriate disciplines (physician, nursing, physical therapy, occupational therapy, speech therapy, dietary, etc.) to ensure that the patient receives the appropriate care and the level of care to promote the improvement of the patient while under the facility’s care. Most facilities will involve family members in these care plan meetings, and a plan will be modified as the patient progresses or worsens under the care of the facility.
• Undertake medical treatment methods to help prevent the deterioration of a patient’s ability to perform activities of daily living. (“ADLs”), including bathing, toileting, dressing, grooming, transferring, ambulating, communicating, and eating. (42 CFR § 483.25.) This provision requires nursing homes and their staffs to undertake measures not to make a patient worse under their care. There is a rule of medicine that holds “first do no harm,” meaning that whatever treatment is provided it should not make the situation worse. This rule of medicine applies equally to the nursing homes and their staff.
• Prevent the development of pressure sores and provide the appropriate treatment where a patient has pressure sores. (42 CFR § 483.25.) Proper skin care and frequent monitoring for residents of nursing homes are essential. Open wounds provide an avenue of exposure to bacteria and viruses that might be prevented in the absence of such wounds. Ensuring that a patient is in the proper type of bed, is turned or rotated frequently, is gotten out of bed frequently, is kept clean and dry if incontinent, and is given proper nutrition and care may be the most essential aspect of nursing home care that there is. Family involvement is important, and your loved one should be checked periodically by you for skin wounds as well.
• Prevent falls, trips and other events where patients can be injured. (42 CFR § 483.25.) Other than bedsores, falls in nursing homes seem to be the most prevalent events that occur. When a patient is admitted to a nursing home, a fall risk assessment should be performed. The fall risk assessment will determine what degree of assistance the patient needs to get out of the bed, out of the chair, to walk, to get to the bathroom, etc. The greater the instability exhibited by the patient results in a higher standard of care to help with fall prevention. Many methods exist in nursing homes to greatly reduce this risk, including assistive devices (such as wheelchairs, walkers, etc.), lifting devices (such as Hoyer lifts, gait belts, rails, etc.), stand-by assistance (one-person and two-person assist), and other aides (such bedside commodes, bedpans, adult diapers, etc.). It is imperative that the patients be monitored as regularly as possible and that all means available be utilized to reduce the risk of falls and injuries. Studies have shown that the older a person is the harder it is for that person to recover from a fall, especially where bones are fractured or other injuries occur. Be sure to discuss with your facility administrator any concerns that you may have about your loved one’s difficulty or inability to ambulate.
• Provide proper nutrition and fluid intake to maintain hydration and nutrition levels. (42 CFR § 483.25.) Oftentimes, elderly patients simply do not eat or drink enough. It is essential for the nursing staff to monitor the patient and ensure that he or she is adequately hydrated and fed. There are numerous ways to do this. Moreover, many of the medications that elderly patients take increase the risk of dehydration, which even furthers the responsibility to monitor the patient. Lack of hydration and nutrition can cause a host of medical issues, including kidney, heart, and lung problems. These problems are often fatal in elderly patients.
• Avoid medication errors. (42 CFR § 483.25.) Medication errors can result in a harmless oversight or a fatal event. Giving the right medication at the right time to the right patient is the rule of medicine. If a patient is given the right medications but at the wrong time, drug interactions, physical functions, and the like could result.
While there are many other similar rules or regulations, these are the ones that are the most pertinent and the ones that we see violated the most. Be sure to visit with your loved one regularly and report any change in their behavior or appearance to the nursing personnel or to his or her doctor promptly. If you need more information on Nursing Home Litigation and related matters contact Ben Locklar, a lawyer in our firm who handles Nursing Home litigation, at 800-898-2034 or by email at Ben.Locklar@beasleyallen.com.
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