Monitor the social/emotional care plan for your loved one in a nursing home

If you are the advocate for someone in a nursing home — your spouse, parent, friend, relative — you may sometimes notice unusual behavior which is different from what you are accustomed to seeing with your loved one. Speak up. Ask the social worker what has changed. Is there a new roommate? A different aide waking the resident up in the morning? Is there another resident who is bothering your family member? Is there a new low grade medical condition such as a urinary tract infection, dental problem or pain? Why is the resident more fidgety, anxious, or quiet? What is causing these “Mental and Psychosocial Adjustment Difficulties?” This issue pertains to the resident’s difficulty in adapting to change in routine or to  stressors  they cannot understand.

Federal nursing home law, 42 CFR secn. 425,  requires that  ” Each resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and plan of care.”  On the subject at hand, section (f) says:” Mental and Psychosocial functioning. Based on the comprehensive assessment of a resident, the facility must ensure that—

(1) A resident who displays mental or psychosocial adjustment difficulty, receives appropriate treatment and services to correct the assessed problem, and
(2) A resident whose assessment did not reveal a mental or psychosocial adjustment difficulty does not display a pattern of decreased social interaction and/or increased withdrawn, angry, or depressive behaviors, unless the resident’s clinical condition demonstrates that such a pattern was unavoidable.”
The mental and psychosocial needs of each resident must be continually addressed on an individual basis to take into account the ability of the individual resident and changes in behavior or mood that become apparent from time to time. Detailed guidelines called SOMS have been issued by the federal government to further explain the duties created by the regulations:  som107ap_pp_guidelines_ltcf

I came across a book that was written for nursing home administrators but could be a useful guide to the lay advocate who is watching out for a loved one in a nursing home. http://ltcsbooks.com/books/social-service-care-plans The book is Psychosocial Care Plans: Social Services Care Plans for Long Term Care,  By Debra Collins, RN, RAC-CT.

Remember – the squeaky wheel gets the oil, and nursing homes have a duty to provide a plan which addresses your loved one’s problems.

For legal representation and advice on nursing home admission and care plans, contact us at 732-382-6070.

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