Top Twenty Problems with Skilled Nursing Facilities (Part Two of Four)

Many of our clients have approached us for advice about nursing home placement for a loved one. Part One of this blog explored five common problems outlined in Justice in Aging’s 2005 article “20 Common Nursing Home Problems—and How To Resolve Them.” Part Two will highlight five more issues to consider.

#6 Forcing Family Members and Friends to Take Financial Liability. It is imperative that you understand that a nursing home generally cannot require anyone but the resident to be financially responsible for nursing home expenses. (However, a relatively new law in Connecticut does allow a nursing home to sue any individual who has received a gift from a nursing home resident which affects the resident’s eligibility for Medicaid. We will discuss this more in a future blog.)  Be very aware of anything being signed, including the initial application paperwork needed for admission. If at all possible, it is best for the resident to sign the admission paperwork themselves. Some nursing homes ask for the signature of the “Responsible Party,” which is a person deemed financially liable for nursing home expenses. In some instances, family members sign this because they believe it is simply stating that they will be a contact person for the resident. Nursing homes have threatened to sue family members and friends who have tried in good faith to help the resident due to these “responsible party” agreements.

#7 Forcing Residents to Give up Legal Rights and Commit to Arbitration. Some nursing home staff members ask that a resident sign an arbitration agreement which states that if there are any future disputes, the parties will not go to court, but rather meet with an arbitrator, or private judge. There is no need for a resident to agree to arbitration at the time of admission. If in the future a dispute should arise, it should be the resident’s right to decide then if arbitration is the best course of action.

#8 Disregarding Resident Preferences. The simple fact of the matter is that when a resident moves into a nursing home, they should be made to feel as though they are at home and not as though they are one of many in a medical assembly line. Nursing Home Reform Law states that reasonable measures must be taken by staff to honor residents’ needs and preferences. It is the responsibility of the resident and his or her family members to advocate and make sure that any proposed changes in care are stated and supported with facts about the resident’s history and preferences. For example, a resident can choose the activities in which they would like to participate and the resident can state that they want to sleep later and have breakfast at a different time than other residents. Staff should be able to adjust and accommodate these kinds of requests.

#9 Failure to Provide Necessary Services. Care should be provided by the staff members at the skilled nursing facility. It should not be an expectation that the resident or their family hire a private-duty aide to assist the resident with their activities of daily living. It is not acceptable to claim shortage of staff or money as an excuse as to why necessary services have not been delivered. If you feel necessary services are not being delivered, raise the issue at a care conference meeting or contact your state’s long-term care ombudsman.

#10 Imposing Visiting Hours. In an effort to be consistent with the philosophy that nursing homes should feel like home, the Nursing Home Reform Law also states that visiting hours for family and friends cannot be imposed. Staff needs to take into account that family members and friends might not be able to visit during standard “business” hours due to time-consuming jobs and family lives. It could also be part of a resident’s personal history that they prefer to visit with friends during an early morning or late evening hour. It is customary, if that is the case, to have your visit in a common area of the facility so as not to disturb other residents who might be sleeping. For family advocates, it also might be best to visit your loved one at different hours of the day and night so that you can get an impression of the care being provided during different shifts.

Check back on our site for Part Three of this blog which will continue to discuss things to keep in mind when working with a skilled nursing facility. If you have questions on behalf of a loved one considering skilling nursing, contact our office at 860-769-6938.

 

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