by Leslie Finnegan, ESQ
Once a Facility is Chosen, Keeping the Lines of Communication Open with Staff a Vital Part of the Process
As the “baby boom” ages, and the cost of medical care skyrockets, more and more families face the prospect of placing a loved one in a nursing home. This decision, and the complexity of it, can be daunting. How does a family find a good nursing home, and what can be done to protect the elder once a facility is chosen?
This article is written by an attorney who sues nursing homes, to help you prevent and avoid nursing home abuse and neglect. This article assumes that your loved one needs help with most or all activities of daily living, is on medication, and suffers from a chronic medical condition, a recent injury, or dementia/Altzheimer’s. This article focuses on nursing homes, because nursing home residents are the most vulnerable, and nursing homes are where most abuse and neglect occurs. Independent living facilities, retirement communities, board and care homes and other “residential care facilities,” which offer limited or no medical care, are not discussed here.
How do I choose the best facility?
1. Research, research, research, and start before your loved one gets sick. Begin by talking to your doctor, your loved one’s doctor, your friends and neighbors. With enough asking around, you will learn which nursing homes are considered “the best in town.” Once you have narrowed the field, find out if each facility has a waiting list and if so, get your elder on it. In many communities, the wait can be over six months. If at all possible, choose your nursing home well in advance. Decisions made in emergency situations often result in a poor choice, or in moving the elder from one facility to another.
2. Assess your loved one’s financial situation. A good nursing home costs between $4000 – $8000 per month, and Medicare only covers the first 120 days. Unless your elder is able to privately pay at least $60,000 per year for her care, consult with an attorney who specializes in Medi-Cal planning. Find out if the nursing home accepts Medi-Cal, and how many Medi-Cal beds it has. This is important, because your goal is to find a great facility while your loved one still has resources, so that she will not be forced to move, or to seek nursing care as a Medi-Cal-only patient.
3. Once you have decided on a facility, research the history of the facility via the Internet. Good websites include Canhr.org (California Advocates for Nursing Home Reform), memberofthefamily.net, nursinghomeguide.org, hospital-data.com and nursingbug.com. Nursing homes are heavily regulated under state and Federal law, and citations for violations of health and safety laws are public record. Look for a facility with no citations or only citations in the “B” category.
4. Have the nursing home admission contract reviewed by an attorney before your elder signs it. And do not sign an arbitration agreement.
Now, how do I protect my loved one?
1. Do not make the mistake of thinking that your loved one is getting the same care he would receive at a hospital. The overall level of care at nursing homes is generally lower. You cannot trust the nursing home doctor, the nurses or the CNAs (nurse’s assistants) to ensure that the resident receives good care. For your loved one to safely live at a nursing home, you must stay vigilant and involved.
2. Visit often, and get to know the staff. Find out their full names and keep a running list. Get to know the other residents and their families. Get to know the ombudsman. Go to the care conferences. Residents with involved families get better care, and are abused/neglected less often, than residents with few visitors.
3. MOST IMPORTANT – Keep in contact with your elder’s outside doctor, and take her to see that doctor several times per year, even if you have to pay for the visits out-of-pocket. At the intake interview, the resident will be told that she can choose her own doctor. Because most outside doctors do not make housecalls, the resident will often designate the facility’s doctor as her treating physician, thinking that “all doctors are about the same.” Believing this is a big mistake. Many nursing home doctors run a “volume practice” and are responsible for hundreds of patients at numerous facilities. They may have minimal actual contact with their patients. If your elder designates the facility doctor, it is vitally important that the outside doctor stay in the picture, at least to a limited extent. The outside doctor can spot/treat conditions that indicate neglect (urinary tract infections, other infections, bedsores, falls, improper use of medications, vitamin deficiencies, etc.). The outside doctor can request the elder’s medical records without arousing suspicion. If there is a problem with abuse or neglect, the outside doctor can complain to state authorities, which will make it far more likely the complaint will be investigated and addressed.
If something happens…
1. If your elder keeps getting infections, is not kept clean, develops a bedsore or falls, do not believe that these conditions are “inevitable” – they are not. These are signs of nursing home neglect. Other signs are dehydration, overmedication, no doctor care, no nursing care and inadequate turning. Neglect can occur quickly, or over time and can be life-threatening. If these symptoms are not immediately addressed, do not wait for the nursing home – take your loved one to the outside doctor. Take photos of any visible injuries (label with date and time) and write down the names of any witnesses.
2. Nursing home abuse includes physical assault, sexual assault, verbal abuse, theft of money/personal property, unfair eviction and “hospital dump” (where the resident is taken to the hospital and left there unattended). Report these events to local law authorities and/or contact an attorney immediately.
3. Contact the ombudsman. If the problem is serious, you may want to report the incident to California Department of Health Care Services (“DHCS”), and have the outside doctor and your attorney make separate complaints. Because DHS only investigates a small fraction of complaints in a timely manner, be the “squeaky wheel.” Begin immediately looking for a new placement if your elder needs to move.
The bottom line is - stay connected, stay awake, and get your money’s worth. There are good nursing homes out there – take the time to find one. Don’t invest trust in the nursing home staff, unless that trust is earned. Don’t be afraid to ask questions, seek second opinions, or follow your intuition. Join CANHR. Know that there are many good people, and good resources, available to support you. In these ways, you can protect your elderly parent, grandparent, brother or sister, at a time in their life when they cannot protect themselves. You will also be part of the effort to raise awareness and the standard of care for all nursing home residents.
This article is intended to address topics of general interest and should not be construed as legal advice.
© 2012 Noland, Hamerly, Etienne & Hoss