Comment: It's a good idea to find out how many people work there and
what the usual staffing pattern is. "
Reality: Impossible except by auditing the payroll books. Looking at the
daily roster at each station does not reflect the true picture. It might show 5 CNAs on duty but one or more might be
absent or sent to another station that is short. Even if you find the CNAs it does not mean they have a realistic work
load unless you know who their residents are.
Comment: Visit the nursing home at different times of the day and form a good relationship with the certified
nursing aides who provide the bulk of the hands-on care
Reality: CNAs won't talk with you in fear of their job. If you ask a question you will
get an avoidance answer.
Comment: Shop around for nursing homes that are certified for Medicare and Medicaid.
Reality: This is good advice. Medicare is for 20 free days, the other 80 days are CO-payment
$100+ per day.
Medicare provides information about Medicare and Medicaid certified nursing homes
throughout the United States on its Web site.
Reality: “Medicare Nursing Home Compare" is the site. It tells the results of survey
deficiencies both in care and fire safety. Then it shows "correction" which is a plan to correct, not necessarily done,
but part of the game. Because of the high staff turnover the data has little impact on decisions.
Comment: Medicaid does pay for
long nursing home stays for those whose income and savings can't cover the cost
it comes to eligibility there is the Miller Trust for income over the cap and spousal impoverishment for the remaining
community spouse. Best to be poor.
Comment: As your parent's advocate, you should know your rights.
to know the State and Federal published rights which are full of loopholes; change frequently. The RIGHTS are those YOU
think you should have. When you are told by facility staff that a decision is based on corporate policy you can disregard
When a law is passed it usually says "the department shall make rules to correspond with
the intent of the legislation." The rules can change with proper input from concerned persons.
Menu in the kitchen. When questioned by residents/families it was changed to menu in the dining area with
substitutes for all to see.
Diet: A State
nutritionist speaker told a resident who wanted bacon with her breakfast that it was up to the doctor to agree. Not
true. She is her own boss and got bacon.
Only can be seen if the person is diabetic. Not true. Tell the doctor your foot problem, ask him to order a podiatrist
if the nursing staff isn't doing their job. If doctor won't do it pick another doctor or ask to talk with the facility
Medical director: Each facility has a medical director
who is charge of all the doctors and the care. Eighty-six percent of responding medical directors report spending 8 hours
or less per week at the facility. Diapers: Company policy might be cloth diapers to save money. If you feel
they are inadequate or dirty you have the right to demand disposable diapers or others that are more appropriate. You
only have to pay if you want a diaper that is more deluxe rather than adequate.
Formerly a facility could inform the family they could not meet the resident's needs therefore the resident had to be removed.
If not, the resident was sent back to the family by ambulance or cab.
Advocates questioned the concern. The facility contracts with the State to provide designated services. Therefore,
they should be more specific as to which needs they cannot meet and where those needs can be met. Once the facility
accepts the person they should be responsible for the continued care. The regulations were changed so that now the facility
has to identify the needs, where they can be met, see the person gets there with appropriate medical data.
Medication: Nursing home residents on Medicaid get unlimited prescribed drugs. Many studies say they are
overmedicated or wrongly medicated. Family should monitor the drugs by watching for necessity and side effects.
The consulting pharmacist gives his findings to the doctor and director or nurses. Neither one has to follow his recommendations;
Comment: More than half of residents don't have
anyone to visit them on a regular basis for whatever reason.
Reality: Visitors have the right to speak up on behalf of any abuse/neglect they see regardless if it is their loved
one or not. The law is specific to everybody:
§ 242.122. REPORTING OF ABUSE AND NEGLECT.
(a) A person, including an owner or employee of an institution, who has cause
to believe that the physical or mental health or welfare of a resident has been or may be adversely affected by abuse or neglect
caused by another person shall report the abuse or neglect in accordance with this subchapter.
Each institution shall require each employee of the institution, as a condition of employment with the institution, to sign
a statement that the employee realizes that the employee may be criminally liable for failure to report those abuses.
A person shall make an oral report immediately on learning of the abuse or neglect and shall make a written report to the
same agency not later than the fifth day after the oral report is made.
Acts 1989, 71st Leg., ch. 678, § 1, eff. Sept. 1, 1989.
Comment: Community resources such as religious organizations, social
workers and nursing home professional associations can provide you with general advice when choosing a nursing home.
Reality: Forget about this.
Most don't know beans about nursing homes and what they do know usually is misinformation given out by the nursing home industry.
Comment: Corporate always use the excuse of low reimbursement for
their lack of quality care.
Reality: The reimbursement is based on the
average money spent by the 1100 nursing homes in the State. Averages reward the least spenders. Example:
If one spends $100 on care and another $50 the average is $75. The $100 loses $25, the $50 gains $25. So the focus
is to spend less to get back more.
A deputy commissioner at nursing home regulatory asked me to tell him if I ever find out
how much money nursing homes really get. Even he doesn't know.
The therapy department in the facility charges Medicare for what they
do. You should be getting the report from Medicare when it pays for some of the work done. So the nursing home
is not paying for everything.
Comment: A family council can help everybody concerned. These councils arrange educational
programs on reducing stress and even plan holiday events involving the nursing home staff. One council recognized a deserving
nurse aide and also sponsored a garage sale to pay for a new garden for the residents.
Reality: This is why most family councils don't
work. Recognizing an aide or raising money to beautify the facility should not be the function. This should be
the responsibility of the facility with the cost as an allowable expense. It is good worker relationship and property improvement.
Family councils should have a board made up of community people.
They should know where to find the real answers to problems. They should interact with Regulatory, Ombudsman, Legislators
of the facility district, Media.
But most IMPORTANT is for the families to have input to the Board with
their concerns. Telling the facility staff without board oversight usually gets the answer in favor of the facility
with the wrong information. So when dealing with facility staff made sure a copy is given to a board assigned member
for follow up.