Friday, November 7, 2014

CRITICAL INFO: Entry 1: Medicare/Medicaid State Operations Manual

Attending a meeting of a group I started at Mom's facility, a Family Council, family members expressed many of the same concerns, problems and issues we faced during Mom's two year stay.

New Administration in now for almost two years; new food service just put in place. What's changed? From visiting, observing and now listening to family members, very little. In fact, in some areas it's getting more challenging for residents and their families.

With this in mind, decided to go back through my dozens of files on information concerning Rights of Individuals living in facilities and putting them here, on this blog, hoping more people in the United States will be drawn to reading small sections and passing this blogsite and its information along to friends and families.

SUGGESTION:  Make a list of these Rights by exact entry, number and quote the verbage as it is written. Your voice has more meaning when you use this approach. Copy it down, don't depend on memory; carry this one and the others I'll write about with you. When needed, you'll have them with you.


As we age we all face a time when we will be "taken care of" by someone other than ourselves. We may need to live in a facility. That place should be safe, welcoming, and provide safety, security and compassion.

This entry begins an overview of areas I've found highly important for those who walk the road of responsibility working with or managing the care of a loved one living in a facility.

You can access the manual  Transmittals PP by going to the following site location:

It's 667 pages long and a great reference. The one I'm using for these entries latest update is currently Rev. 107 dated 04-14-14. As time passes, these entries may contain additions or deletions, there may be more sections. Please check for the latest information if this is blog is being read far past the posting date of 11-07-14.

CHALLENGE:  In facilities, it's mostly verbal communication. Even though they are required by law to keep written documentation, during visits and at Resident Care Planning meetings, we did not receive any written report, everything was verbal.

What about you who are reading this entry? What's your experience? Reminds me to find a way to put a Poll on this site. Learning as I go.

Here's the exact citation from the Medicare/Medicaid State Operations Manual governing all the United States as linked above:

#1  Resident and/or Legal Representative has/have the right to access by verbal request all records. FACILITY CANNOT MANDATE A WRITTEN REQUEST

Why do you think this is important, verbal being enough to obtain records? Possible physical challenges limiting ability to write; eyesight challenges or other limitations often come with aging.      
                Limited abilities should not limit accessibility.


§483.10(b)(2) -- The resident or his or her legal representative has the right--
  1. Upon an oral or written request, to access all records pertaining to himself or herself including current clinical records within 24 hours (excluding weekends and holidays); and (ii) After receipt of his or her records for inspection, to purchase at a cost not to exceed the community standard photocopies of the records or any portions of them upon request and 2 working days advance notice to the facility.
Interpretive Guidelines §483.10(b)(2)
An oral request is sufficient to produce the current record for review."

(1) oral OR written request for access to records
(2) access MUST BE granted within 24 hours --
                        (excluding weekends and holidays)
(3) AFTER receipt of records for inspection, to purchase at a reasonable
      community standards (think library copying or Office Supply Store)
      standard photocopies of the records OR ANY PORTION of them
(2) 2 working days advance notice

PLEASE NOTICE:  There is no time of day/night specified allolwance for your completion of your examination. UNLESS THERE ARE OTHER FEDERALLY  OR STATE MANDATED LIMITATIONS, you have the right to review these documents (1) more than once (2) on a basis of multiple days at a time esp in the beginning

#####THE CHALLENGE######## Unless you request "all records" and include any "historical records on file obtained from outside sources" or specify exact types of files, reports, papers, you may be given whatever the facility "wants you to have" and claim those are the "records".

In another entry we'll examine the specific types of records kept by long term care facilities which you can use as a reference.

RESIDENTS AND LEGAL REPRESENTATIVES:  You have the right to request a formal, written copy of the resident's Care Plan and any and all reports that directly affect decisions made by the facility on that Care Plan.

TO PROTECT OUR SENIORS, to judiciously manage their care, to ensure effective use of funds through systems we all pay for -- Medicare and Medicaid -- more effective record keeping and sharing should be a top priority.

Question: Did you know you, the resident, or the appointed representative and/or both, can review and determine and consult outside of the facility or get another opinion (probably at your own expense, but you have that choice; check your medical coverage) concerning the Care Plan.

KEEP THOSE COPIES. They're valuable papers in understanding treatment and progressions or regressions.

My writing, your reading and for those of you who choose, your submissions of additional information, will protect our loved ones when we cannot be with them and ourselves, as we age and move through various life challenges and stages of life.

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