My dad lives in a nursing home, and I've become suspicious about some of its practices. What specifics should I look for and who do I turn to for help, especially since I fear any repercussions might fall on my father?
- Denise Daughter
Dear Ms. Daughter: Having been in the same predicament, I can certainly empathize. As we Boomers age, more and more seniors have no familial or financial recourse but to enter a nursing home. If these folks are fortunate, the facility is reputable and clean with enough compassionate and caring staff. However, it seems more and more that this type of environment is on the decline rather than the rise.
Since you don't specify any of the practices you believe to be harmful to your dad, I'll address some of the more common concerns, as well as a few we normally don't think about. Before beginning, though, it's urgent you know your rights under the federal Nursing Home Reform Act of 1987. It applies to every single nursing home throughout the country that's certified to accept Medicare and/or Medicaid patients. Some of the more important aspects of this law mandate the right to freedom of choice over medical care, the right to refuse treatment and the right to advance notice of changes to the patient's care or treatment plan. Unfortunately, many nursing homes ignore the law and, all too often, get away with it, especially because a family fears retaliation for its family member if making a formal complaint or are frightened the patient will get kicked out. (While the former does happen, the latter is illegal.)
So what should you do in preparation for your loved one entering a nursing home? First, check out www.nursinghomealert.com for details on federal regulations. Secondly, according to SmartMoney, it's urgent to know the facts that many of these places don't volunteer:
1. Some misuse drugs and, especially, antipsychotic meds which have dangerous side effects or drugs to sedate patients. Despite legalities, residents' or their families' informed consent is often ignored, especially when prescribed for disciplinary reasons, such as to prevent agitation in Alzheimer's dementia.
2. Stolen personal property adds insult to injury to already out-of-sight nursing home fees. SmartMoney tells us that the new Patient Protection and Affordable Healthcare Act ("Obamacare") creates a national system of background checks to keep those staff with sticky fingers (and other issues) out of the long-term health care setting. Even though the American Healthcare Association spokespersons assure us the agency supports criminal background checks, embezzlement frequently occurs.
3. Not adhering to the patient care plan (or how the staff is supposed to treat a patient) can be a problem, particularly in smaller nursing homes.
4. Neglect and/or outright abuse are truly scary thoughts, but this scenario does happen, and too often. Pressure/bed sores, dehydration and malnutrition are among the biggest three citations.
5. Inadequate staffing is THE real biggie. In fact, some of the other problems occur, in large part, because of the pathetic salary and the high, high, high ratio of too few workers to too many residents. Worse, the populations of us age 65 and over is expected to grow to 72 million by 2030, so the staffing problem isn't going away.
6. Physical restraints, such as the usage of vests or belts that tie residents to wheelchairs or beds, while declined in use, are still employed by some nursing homes. Both physically and emotional damaging, restraints are illegal unless in situations where the person might harm himself.
7. Feeding tubes take a patient's freedom of choice away. Some nursing homes use the tubes to save time and labor with patients who eat too slowly.
So what can we do as consumers to effect change and help those in nursing home care and their relatives? Before deciding on a place, check www.projects.propublica.org/nursing-homes that lists inspection reports for more than 60,000 nursing homes. Once you've established the best nursing home, be sure to do the following: investigate matters before lodging a complaint to be sure it's justified; establish good working relationships with the staff; don't miss important meetings, such as care plan reviews; and observe, note, and report serious problems about quality of care. Then, just to be prepared, go to www.itcombudsman.org to find contact info for states' free ombudsman program for advocacy purposes.
Ellen Phillips is a retired English teacher who has written two consumer-oriented books. Her Consumer Watch column appears every Saturday. Email her at consumer watch@timesfree press.com.