Wednesday, April 9, 2014

Major Sources for Nursing Home/Long Term Care Rules, Regulations and Individualized Care

A helpful tool is your State's Department of Health and Senior Services published materials for information on the responsibilities of the Long Term Care Facility and the rights of residents, families and caregivers. Here's the site for MO:

A primary person at the facilities should be the Social Worker who is supposed to be the advocate for each individual patient. However, they're employed and paid by the facility or ownership.

Here's a revision of Missouri's Ombudsman (now VOYCE) "The Role of the Social Worker in the Long Term Care Facility" pamphlet originally written as a result of a conference of independent practitioners and academicians from 1985 - 1987, it's gone through three revisions with the latest from 2005-2006 and latest publication in 2008. We've found the Table of Contents on Page 2 most helpful:

Remember, this is a report, a guideline, it has no real legal authority and only the published laws, rules and regulations of the State, the County, the City and Federal Authorities with jurisdiction detail what the realities are regarding the specific obligations of Long Term Care Facilities.

One of our early misconceptions was documents like the above were actually enforceable. They are insights and possible procedures but not mandates. The actual State laws are very broad, rules and regulations are developed to "funnel" down some more specific mandates. Then there are Medicare and Medicaid requirements for receipt of funding.

Some sections of the referenced report from the ombudsman we've found most helpful: Pre Admission Screening, Resident's Rights, most important section: Individualized Service Delivery including areas entitled Care Planning, Minimum Data Sets, Assessments, Notes & Plan of Care. Again, however, go to the actual State Rules and Regulations and there may be several under different areas. One of the greatest assets we have as caregivers and those who are growing older is the internet and its vast abilities to seek and find and refer to other resources.

SUGGESTION:  Spend the small amount of time and money and get a copy of each individual assessment and caregiving plan. The insights you'll gain from the facilities observations and reports as well as what has been submitted to "higher authorities" that must be transmitted to the State and Medicare/Medicaid can be invaluable as time passes.

Be sure to ask what specific reports, evaluations or other State, Federal or other entity required documents the facility must complete, produce or provide and on what regular basis to ensure you have a "total picture". And, always do it in writing; you'll probably have to pay a per page price so you can always ask to review any and all documents and reports and request specific pages or a page. In hindsight, I would do this from day one of entry of a loved one.

SUGGESTION: If you value the quality of life of your loved one, maintain a close and highly observant role and keep a diary, record or notes; today's cell phones and computers make this much more possible to maintain, update and retain words, pictures and videos of your loved one as mentioned in the blog entry:  under Lesson #5.

 Having experienced several Long Term Care facilities for both Rehab Care and Long Term Care, we believe it is the Administrator of the facility and the ownership/top management who generally sets the "pace" for the involvement of all employees and independent contractors "employed" by the facility.

Depending on the "hierarchy" within the facility and the Staff Responsibility Relationship Chart (if there is one) as to whom the Social Worker reports to, is directly responsible to, there can be a wide variance in the actions of the Social Worker, the level of competence and the level of the person's ability and/or responsibility.

As mentioned in the previous BlogSpot entry above under Lesson #6, check not only to see if your Long Term Care facility has a Resident's Council, but that it also has a Family Council. 

KNOW BEFORE YOU GO:  Attend a Family Council Meeting and if they don't have one, ask how the families communicate with one another.

Before you choose to admit yourself or a loved one, attend both of these and at the Family Council, which is open to "everyone" in the community, you do not have to be a family member, ask to see any and all notes from meetings and/or ask to meet with a few of the people you've observed have made both positive and negative remarks about care and services within the facility.


Administration and even ownership changes; since this may be a place you entrust yourself to at a time when you may not be as capable, it's best to Plan Ahead.

Our Advice:  We plan for our education and profession; we plan for our community involvement and choices in what organizations we belong to but we don't consider planning for how, where and why we'll live some of the most important time in our life, the time of most personal care need and the time of least ability to provide it for ourselves -- eventually

And, even if your goal is to remain and to pass "at home", your life may not follow that path of pre-determination. Protect yourself with a level of "insurance" we all deserve -- DIRECT AND CONTINUING KNOWLEDGE.

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