1. NURSING HOMES: IDT & RESIDENT RIGHTS Natalie R. Baker, DNP nrbaker@uab.edu

2. When you hear the word nursing home, what is your first thought?

3. Common thoughts Not so common thoughts  Old-folks home  A place to die  A depressing place  Poor care-urine smells, pressure ulcers  Rehabilitation services  Skilled nursing care  Staff trained to care for frail older adults  A safe home for older adults who need assistance

4. Who pays for nursing home care?

5. Payment Sources  Medicare-Part A  Medicaid  VA  Commercial Insurance  Private Pay http://www.skillednursingfacilities.org/articles/nursing-home-costs.php

6. Regulations Governing NH  Federal 42 CFR Part 483, Subpart B-Requirements for Long Term Care Facilities  State  VA

7. What healthcare disciplines are represented at nursing homes?

8. Healthcare Disciplines  Nursing-RN, LPN, CNA  Dietary-RD, Dietary Manager  Social Services  Activities  Physician Services-MD/DO, NP, PA  Rehab-PT, OT, SLP  Hospice  Podiatry, Dental, Optometry

9. Comprehensive Care Plan “The facility must develop a comprehensive care plan for each resident that includes measurable objectives and timetables to meet a resident’s medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment.” 42 CFR 483.20 The Long Term Care Survey, May 2013 edition, p.17

10. Interdisciplinary Care Plans “Prepared by an interdisciplinary team, that includes the attending physician, a registered nurse with responsibility for the resident, and other appropriate staff in disciplines as determined by the resident’s needs, and, to the extent practicable, the participation of the resident, the resident’s family or the resident’s legal representative…” 42 CFR 483.20 The Long Term Care Survey, May 2013 edition, p.17

11. Frequency of Care Plans  14 th day of admission  Quarterly-revise, develop new CP if needed  Significant Change-revise, develop new CP if needed  Annually-develop new CPs

12. Resident Rights Why was it necessary for the federal government to enact resident rights for nursing homes?

13. Resident Rights “The resident has a right to a dignified existence, self- determination and communication with and access to persons and services inside and outside the facility. A facility must protect and promote the rights of each resident, including each of the following rights:” 42 CFR 483.10 The Long Term Care Survey, May 2013 edition, p.5

14. Resident Rights  Exercise of rights-vote  Notice of rights and services-must receive a copy Access to all MR within 24 hours of oral/written request Copy of all MR within 2 working days-reasonable cost NH must post contact information of advocacy groups Physician contact information Significant condition change reported to MD & family Change in room or roommate

15. Resident Rights  Protection of resident funds  Free choice Choose a personal attending physician Be fully informed in advance about care and treatment Participate in care and treatment plans  Privacy and confidentiality  Grievances Voice grievances without discrimination or reprisal

16. Resident Rights  Examination of survey results  Work  Mail  Access and visitation rights-NH must provide immediate access Physician State representative Ombudsman Family

17. Resident Rights  Telephone  Personal property  Married couples  Self-administration of drugs  Refusal of certain transfers Relocation from SNF area to non-SNF area Relocation from non-SNF area to SNF area

18. Additional Resident Rights  Free from physical or chemical restraints if imposed for purpose of discipline or convenience  Free from verbal, sexual, physical, and mental abuse, corporal punishment, and involuntary seclusion  Organize and participate in residents’ groups  Participate in social, religious, and community activities  Self-determination

19. Self-Determination “The resident has the right to 1)Choose activities, schedules, and health care consistent with his or her interests, assessments, and plans of care; 2)Interact with members of the community both inside and outside the facility; and 3)Make choices about aspects of his or her life in the facility that are significant to the resident.” 42 CFR 483.15 The Long Term Care Survey, May 2013 edition, p.14