Ideas on Overseeing the Care in a Nursing Home When You Can’t Enter the Building

Advocating for our clients in nursing homes during this pandemic has been uniquely difficult, but we continue to utilize whatever tools are at our disposal to help the family members oversee the delivery of care to their loved ones. Many rights are guaranteed, and right now much creativity is needed to protect those rights. Care plan conferences with the treatment team (nursing, dietary, recreation, physical therapy, medical) can be set up in which the family member/ health care representative/ POA (and the attorney, if desired) are on a conference call. Dietary staff can communicate with family about menu selections at the start of the week, using scans or faxes + emails.  It is important to monitor diet because the lack of communal eating and snacking may be causing significant weight loss in residents.

Arrangements can be made for the resident to be brought down to the Lobby so that the concerned health care proxy/involved family member can actually see them through the glass windows or doors. Arrangements can be made for nursing staff to call the family at scheduled times with a report from the shift.  As the weather warms, facilities should be scheduling outdoor visits with family on a regular basis.

Access to the medical record can be arranged, and state law requires the facility to provide access to records to the resident and their authorized requester. Ordinarily, a patient’s advocate/family member who has HIPAA authorization can review the chart during their visit to the nursing facility, in order to stay up to date with the care that’s being delivered, how the resident is functioning, whether there were any incidents and what medications the person is taking. Right now, no third parties are allowed on the premises of the skilled nursing facilities. Since the facility is obligated to keep the families informed about the condition of the resident, creativity and cooperation are needed. Have a discussion with the administrator about a reasonably convenient way that the facility can send this information out – perhaps once a week via fax or scan.

Updates on the COVID-19 situation as it affects seniors and those who care for them can be found here and here.  Many towns have put special programs in place to provide support for frail and housebound community members who are suffering due to the pandemic. The local Aging & Disability Resource Centers can also be useful as an access point for information and services, even though service delivery is not swift during these times.

For help with your unique senior care legal problems, call us at … 732-382-6070

Feeding the Patient is Part of the Plan of Care

What can you do if your loved one can’t feed himself but the nursing home staff just keep leaving the tray on his table? The Nursing Home Reform Act Residents’ Rights 42 CFR Ä 483 requires that provision of adequate nutrition be part of the services provided to all nursing home residents. The facility must provide adequate services to “attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care.” Dietary Services must be included in the Medicaid or medicare daily rate and cannot be billed to the patient separately, and this includes feeding. The facility must provide special equipment if that is what a resident needs to be able to feed him or herself, and in lieu of other certified staff dietary aides, a nursing home may employ a paid trained Feeding Assistants to take care of feeding certain patients who have non-complex feeding needs: ” (i) A facility must ensure that a feeding assistant provides dining assistance only for residents who have no complicated feeding problems.(ii) Complicated feeding problems include, but are not limited to, difficulty swallowing, recurrent lung aspirations, and tube or parenteral/IV feedings.”

I was responsible as legal Guardian for the care of a fellow who was confined to his bed in a nursing home for the last few months of his life due to various illnesses and weaknesses. When I would visit him, I often saw that his meal tray was on his table, the containers were opened, and spoonfuls of food were on the floor or on his bed or on himself. It was apparent that he could no longer hold his spoon. He was rapidly losing weight. The patient insisted that he could feed himself and didn’t need help, but clearly he wasn’t getting the nutrition he needed. Or he’d say he wasn’t hungry – clearly not true, as he ate eagerly when I fed him. I had a discussion with the case manager and they began assigning someone to sit with him and feed him and encourage him to eat.

The family of a nursing home resident is not responsible to feed their frail loved one. This is the facility’s legal duty. Call for a care planning meeting and address this with them if you are told that there “aren’t enough staff” or “not enough time” or “the family needs to do it” or “the patient keeps refusing.”

Call for legal advice about the rights of residents of nursing homes … 732-382-6070