Nursing Homes: Choosing, Paying & Monitoring Abuse
June 15th, 2017 | Richard S. Bishop
The decision to move into a nursing home, or to place a loved one in a nursing home, can be extremely difficult. Finding the “right” nursing home can also be difficult. At HKQ Law, we want to help make the process a little easier for you. Here are some tips.
Find nursing homes in your area.
Ask people you trust - like your family, friends, or neighbors - if they’ve had personal experience with nursing homes as they may have recommendations. A hospital’s staff may assist in finding a nursing home that meets your needs and can help you with your transfer when you’re ready to be discharged. Find out if your doctor provides care at any local nursing homes. If so, ask your doctor which nursing homes he or she visits.
Compare the quality of the nursing homes you are considering.
Visit www.medicare.gov/nursinghomecompare to compare facilities. You can also call the Pennsylvania Department of Health as the State’s Licensing Agency to see if they have written information on the quality of care given in local nursing homes.
Visit the nursing homes you are interested in or have someone visit for you.
Make an appointment to visit. You can also make unscheduled visits as well. Staffing can be different at different times of the day and on weekends. Here are some questions to ask when you visit:
- Is the nursing home close to family and friends so they can visit often? (It is best for the nursing home to be one that family and friend can visit often. People in nursing homes who have regular visitors receive better care.)
- Is the nursing home and its current administrator licensed by the State and are they in good standing?
- Is the nursing home Medicare- and/or Medicaid-certified?
- How long has the facility been certified?
- Is a bed available now, or is there a waiting list? If so, how long will it take before a bed is available?
- Does the nursing home provide a safe environment?
- Are personal belongings secure in residents’ rooms?
- Is the nursing home locked at night?
- Is the facility well lit?
- Does the nursing home have smoke detectors and sprinklers?
- Are exits clearly marked?
- Are handrails and grab bars appropriately placed in the hallways and bathrooms?
- What does the nursing home do to prevent falls?
- How does the facility handle a fall?
- Is the resident checked later in the shift for injuries that were not apparent at first - such as a closed head injury that would make a person act more confused than normal?
- How are family members informed that resident has fallen?
- Does the nursing home conduct background check on their entire staff?
- Are there enough staff members to provide needed care?
- How many caregivers does each resident have?
- Does the staff appear to be overworked?
- How does the staff interact with each other? (That can be indicative of how the staff treats residents.)
- Do staff members interact well with residents?
- Will the staff respond quickly to calls for help?
- Is there is a physician who is used by most of the residents? If so, what are his/her qualifications? How often is a doctor on the premises?
- Can the resident receive care from his/her own physician at the nursing home?
- Does the facility have an Alzheimer’s unit or other special care area restricted to residents with special care needs?
- Does the nursing home make sure residents get preventive care to help keep them healthy?
- Are specialists like eye doctors, ear doctors, dentists, and podiatrists available to see residents on a regular basis?
- Does the nursing home have a screening program for vaccinations including influenza and pneumonia? (Nursing homes are required to provide flu shots each year, but residents have the right to refuse if they don’t want the shot, have already been immunized during the immunization period, or if the shots are medically inadvisable.)
- Does the nursing home have an arrangement with a nearby hospital for emergencies?
- Can the resident’s doctor care for him/her at that hospital?
Food & dining
- Does the nursing home provide a pleasant dining experience?
- Do residents dine in a communal dining room or in their own rooms?
- Does the staff help residents eat and drink at mealtimes if help is needed?
- What types of meals does the nursing home serve? (Ask the nursing home if you can see a menu.)
- Are nutritious snacks available throughout the day and evening?
- Do residents have a choice of food items at each meal? (Are there options and substitutes available if a resident doesn’t like a particular meal?)
- Can the nursing home accommodate special dietary needs?
- Are there resident policies residents must follow? (Get a written copy of these policies.)
If specialized medical services are not available on premises (such as dialysis), how is transportation arranged?
Will they provide transportation to doctor appointments?
- What kind of activities are planned each day for the residents? (Some examples are movies, musical events, religious services, bingo.)
- Which services are included in the monthly fee?
- Which services cost extra?
Get a copy of the facility’s fee schedule. (Medicare- and/or Medicaid-certified nursing homes must tell you this information in writing.)
Nursing home care can be very expensive. In Pennsylvania, the median annual nursing home cost can exceed $100,000. Nursing home care is paid by private payment, long-term care insurance, Veteran’s benefits or Medicaid. Medicare generally does not cover long-term care stays (room and board) in a nursing home. Most people who enter nursing homes begin by paying for their care out-of-pocket. As the individual’s financial resources are “spent down”, he or she may become eligible for Medicaid.
HKQ Law Attorney Richard Bishop notes that “through long-term health care and Medicaid Planning, we can help people qualify for Medicaid more quickly, and we can also help protect homes from Medicaid Estate Recovery liens. States are required by federal law to recover from probate assets the amount of Medicaid spent on a patient following the patient’s death.”
Health care advance directives
The nursing home may ask about the existence of a health care advance directive. There are two common types of such directives:
A living will: A living will is a written legal document that shows what type of treatments your loved one wants or does not want if he or she can’t speak for themselves. Usually, this document only comes into effect if your loved one is unconscious.
A durable power of attorney for health care: This legal document names someone else to make health care decisions for your loved one. This is helpful if he or she becomes unable to make decisions.
HKQ Law can assist in the preparation of these documents.
NURSING HOME ABUSE
It is estimated that about 5 million Americans are affected by elder abuse each year. Unfortunately, not all nursing homes offer a safe refuge. Older persons who live in community settings, such as nursing homes, are abused more often than older persons living in other settings. Studies conducted by the National Center on Elder Abuse found that 44% of the nursing facility residents surveyed had been abused, and 95% of those surveyed reported that they had been neglected or had seen other residents neglected. More than 50% of nursing home staff admitted to mistreating nursing home residents.
Common types of nursing home abuse:
Physical Abuse – The intentional infliction of physical pain or injury to the victim. This may include hitting, slapping, or restraining by physical or chemical means.
Emotional Abuse – The deliberate infliction of mental pain, anguish or distress through either verbal or non-verbal acts.
Sexual Abuse – Any nonconsensual sexual act. This may include unwanted touching, sexual assault or battery, and coerced nudity.
Neglect – The failure of a caregiver to meet the needs of the patient or resident. This commonly occurs when a resident doesn’t receive proper medical, physical, or emotional attention.
Financial Exploitation – Illegally taking, misusing or concealing patient’s personal funds, property or assets.
Warning signs of abuse
- broken bones or fractures
- bruising, cuts or welts
- bed sores
- poor hygiene
- fear of being alone
- frequent crying
- overwhelming sadness
- complaints of poor treatment
Nursing home mistreatment can result in serious injury or even death. If you believe your loved one might have been the victim of nursing home abuse or neglect, contact HKQ Law at 570-287-3000 or online at www.HKQLaw.com. We can help.