What you hear: “Medicaid does not pay for the service that you want.”
The Facts: A Medicaid-Eligible resident is entitled to the same level of service provided to any other resident, Section 483.12(c)(1) of Title 42 of the Code of Federal Regulations. If this is happening to you, tell the facility that you know the law and site it. Don’t get into an argument with them over their Medicaid reimbursement because that is not your problem. If they still refuse to provide the services you are requesting, feel free to give us a call.Number 2: CARE PLANNING
What you hear: “The nursing staff will determine the care that you receive.”
The Facts: The resident and the family have the right to participate in developing the resident’s care plan. A care plan, which should be completed within 14 days of residency and reviewed every three months thereafter, should be by the resident’s physician, a registered nurse and other essential facility staff, but mostly importantly, they should include the resident, their legal representative and/or other family members (See Section 483.20(k)(2) of Title 42 of Code of Regulations) and note that the facility is required to schedule your care plan meeting at a time when others can attend.Number 3: HONORING RESIDENT PREFERENCE
What you hear: “No we don’t have enough staff to accommodate individual schedules. You must wake up at six a.m.”
“No, because of our scheduling, your bath will always be at 2 p.m.”
“No, if you don’t like the meal entree, your only choice is a peanut butter sandwich.”
The Facts: A nursing home must make reasonable adjustments to honor resident needs and preferences;
The Nursing Home Reform Law requires that a facility make reasonable adjustments for residents’ needs and preferences. For example a resident has the right to choose activities, schedules and health care consistent with his or hers interests, assessments and plan of care (Section 483.15(b)(1) of Title 42 of the Code of Federal Regulations.Number 4: PROVIDING NECESSARY SERVICES
What you hear: “No, we don’t have enough staff. You should hire your own private-duty aide.”
The Facts: A nursing home must provide all necessary care. The foundation of the Nursing Home Reform Law is the previously discussed requirement that each home provide the care that a resident needs to reach the highest practicable level of functioning (Section 483.25 of Title 42 of the Code of Federal Regulations). A resident or their family member should make clear that is it the nursing home’s legal responsibility to provide necessary care and lack of staff or funds is no excuse.Number 5: LIMITING USE OF PHYSICAL RESTRAINTS
What you hear: “If we don’t tie your father into his chair me may fall or wander away from the nursing home. There’s just no way we can always be watching him.”
The Facts: Physical restraints cannot be used for the nursing home’s convenience or as a form of discipline. A physical restraint is a device that restricts a resident’s freedom of movement. It can be a vest, a belt that keeps a resident in a wheelchair, a seat belt, bed rails or a chair that is angled back to prevent a resident from standing up.
Under the Nursing Home Reform Law, a physical restraint can be utilized only to treat a resident’s medical conditions or symptoms. (Section 483.13(a) of Title 42 of the Code of Federal Regulations.)
If a facility is using restraints instead of keeping a watch on your loved one, it’s the same as tying a baby up to keep it from getting into things. Don’t let this happen to your loved one. Site this law and make sure they know that it is their job to watch your loved one to ensure their safety.