Answers to Frequently Asked Questions
for Persons Dealing with Nursing Homes
Why do people live in nursing homes?
People who live in nursing homes generally do so either for rehabilitation or long-term care. When you live in a nursing home for rehabilitation, the goal is for you to progress to the point where your return to live in your own home. When you live in a nursing home for long-term care, it usually means you have certain medical issues which make it unsafe for you to live at home.
What is the role of the Administrator of the nursing home?
The Administrator is the individual licensed by the State of New Jersey who is ultimately responsible for what occurs at a nursing home. A nursing home is not allowed to operate without having a licensed Administrator. In nursing homes that do not function smoothly, there is usually tension between the owners of the nursing home, who commonly make decisions based upon maximizing profits, and the Administrator, who is responsible to ensure that the nursing home satisfies all State and Federal regulations.
What is the role of the Director of Nursing at a nursing home?
The Director of Nursing is a Registered Nurse (RN) licensed by the State of New Jersey. She is responsible for supervising all nursing activity at the nursing home. Her duties include maintaining the nursing home’s nursing policies and procedures manual. She also trains and supervises other Registered Nurses, Licensed Practical Nurses (LPNs), and Certified Nurse Assistants (CNAs).
What is the role of the family doctor \ primary care physician for a nursing home resident?
The Primary Care Physician (PCP) plays an important role in the health and well-being of the nursing home resident. In a simple sense, it is the job of the nursing staff at a nursing home to simply follow the orders provided by each resident’s physician. The PCP is responsible for instituting doctor’s orders and changing them when it is appropriate. A PCP is only required to examine a nursing home resident one time per month. It is the job of the nursing staff, who see each resident every day, to communicate any significant information or change in a resident’s condition to that resident’s family and their PCP. When a PCP is informed one of their patients was hospitalized for neglect that occurred in a nursing home, they frequently respond by asking why the nursing home did not notify them of changes in the resident’s condition sooner.
At the initial meeting, the resident’s family is frequently told that the resident’s current PCP does not have permission, or privileges, to enter the nursing home. The family is then customarily handed a short list of PCPs who do have permission to treat residents at the nursing home. Families need to be extra careful when deciding whether to accept a PCP who receives regular patient referrals from the nursing home. In these situations, the family needs to look out for situations when the PCP may make decisions that appear to be in the best interests of the nursing home rather than the resident. Since nursing homes are set up under the theory that the PCP acts as the advocate for the resident, it is problematic for the resident when that is not the case.
What are the biggest problems families experience with nursing homes?
One of the biggest problems a resident’s family experiences is the failure of the nursing home to communicate significant information about the resident to their family and PCP. The resident’s family members and PCP cannot be at the nursing home 24 hours a day. They rely on the nursing home to provide them with important, timely information so decisions can be made that are in the best interest of the resident. When information is not provided in a timely fashion, opportunities to prevent injuries or to reduce the severity of injuries are often lost.
Inexplicably, nursing homes have also been accused of hiding injuries and harassing families who try to take photographs. As a family member, you have the right to know whether the nursing home resident’s skin is intact. Nursing staff is often accused of forcefully requesting that family members leave the room whenever the resident’s briefs, clothing or bed linens are changed. Families need to find appropriate opportunities to insist on staying and inspecting all areas of a resident’s skin. Nursing home staff and administration often become aggressive whenever family members try to take photographs to document bedsores. Administrators have been known to lie to family members about HIPAA laws claiming the law prohibits families from photographing nursing home residents. Administrators have also been known to call the local police and accuse families of harassment and disorderly conduct. Nursing homes know the documentation of injuries with photographs makes it much more difficult for the nursing home to claim they provided appropriate care.
What is a Care Plan Conference?
A Care Plan Conference is a meeting that the nursing home is required to conduct under federal law. The nursing home must invite the resident’s family, PCP, and different disciplines from the nursing home. At a Care Plan Conference, the specific needs, risks, and goals for each resident are discussed and implemented. Representatives from the nursing home should include the Administrator, the Director of Nursing, as well any other employees of the nursing home who work in nursing, nutrition, physical therapy, occupational therapy, and social services who are involved with the resident’s care. It is important that family members attend a Care Plan Conference so the nursing home has as much information about the resident as possible. Through such attendance a comprehensive Care Plan addressing the needs and risks for the resident can be implemented.
Why is good communication important in the nursing home?
Good communication is important in a nursing home because family members and PCPs are not at the nursing home 24 hours a day. It is the job of the nursing staff to follow the doctor’s orders, and to notify the PCP and the family whenever there is a change in the condition of the resident. Timely communication of information gives the resident’s PCP the most options and best chance to help the resident with options such transferring to the hospital, or to change the doctor’s orders or medications that the resident is receiving.
What can the family do to help?
The family should attend the Care Plan Conference. The family should review the Care Plan with the PCP. The family should visit the resident at different times during the day. Overworked and underpaid nursing staffs that do not provide good care will learn if your family visits at the same time every day. That nursing staff will often pay special attention to the resident during these times, and feel that is acceptable not to pay attention when there is no expectation that any family members will be visiting. The family should also communicate to the nursing staff that they would like to be present during the clothing changes, when appropriate, to inspect the resident’s skin.
The family is also best served to learn the names of the nursing staff. If you think there may be a problem, write down names, dates, times, and what happened. All complaints or problems should be made in writing to the Administrator, to prevent the nursing home from later taking the position that they were not aware of the family’s complaints. The family takes many photographs of the room and the resident. This is especially true anytime that the resident experiences skin breakdown, or if the family witnesses any other suspicious injuries or situations. Some families have even successfully installed cameras to document abuse.
What injuries frequently occur in nursing homes?
The most common types of injuries sustained in nursing homes are pressure ulcers and falls resulting in fractured legs and hips. The chances that these types of injuries will happen to a particular resident can be significantly reduced by good nursing care. Nursing homes have tools at their disposal to gauge the risk that a resident will experience skin breakdown, and the risk that a resident will suffer a fall. If a nursing home properly assesses the risks for each resident, the appropriate precautions can be implemented to reduce the risk that the resident will suffer these avoidable injuries. It is then the job of the nursing staff to consistently and comprehensively follow the doctor’s orders when caring for the resident.
Who is the Ombudsman?
The Office of the Ombudsman for the Institutionalized Elderly investigates allegations of abuse and neglect for people age 60 and older, who live in nursing homes and other long-term healthcare facilities. “The Ombudsman” is like the police department over nursing homes. The Ombudsman maintains a 24-hour hotline for complaints about abused and neglected nursing home residents: 1-877-582-6995.
What is an arbitration agreement?
An arbitration agreement is a legal contract. It is often submitted as part of dozens of documents the resident or their family is required to sign before the resident is admitted to the nursing home. An arbitration agreement makes the signor agree that they have no right to go to a court before a jury to settle any dispute they may have with the nursing home. This includes any injuries the nursing home may cause, no matter how bad the injury is, or how poor the nursing care provided was. You should refuse to sign an arbitration agreement any time you are asked to do so.
– Ernest L. Alvino, Jr