By JUDD MATSUNAGA
This is the final article to the six part series “What to Do with Grandma?” As you may recall, in Parts 1 and 2 we covered how to provide care for Grandma at home or at a retirement home. In Parts 3 and 4 we addressed how to find a nursing home and how to qualify for Medi-Cal. In Part 5 we focused on protecting the family home.
Now that Grandma is in the nursing home being paid for by Medi-Cal, this last article will cover how to make sure Grandma is safe and gets the best of care. “What do you mean ‘safe’? Doesn’t Grandma get 24/7 care?” Unfortunately, there is an avalanche of lawsuits against nursing home owners, administrators, directors of nursing and attending physicians for lapses in care.
The purpose of this article is to impart some “inside knowledge” so you can protect Grandma from these lapses in care before they can cause harm. According to Dr. Andrew Weinberg, director of geriatrics and extended care at Dorn Medical Center in Columbia, S.C., you, the family member, must become informed and involved to ensure that Grandma will receive the best possible care at all times.
In his book “How to Keep Your Loved One Safe in a Nursing Home,” Dr. Weinberg lists “10 golden points to always remember”:
1. Guilt for placing someone in a nursing home will be laid on you either by your loved one himself/herself or by another relative. Adjust to it the best you can and focus on providing the best care you can arrange.
2. Talking to family members of other nursing home residents will immediately identify problem areas to watch out for in the facility.
3. Don’t ever leave any valuables with your loved one in the facility. No matter how much these items mean to the individual, if it has value it may get stolen or lost at some point. If you wish, you may bring the item for your loved one when you visit and take them back when you leave for safekeeping. You can also consider using cubic zirconium diamonds to substitute for real ones (if you use this option, let the staff know).
4. Always contact the attending physician directly by telephone after your loved one is admitted to the nursing home. The main office of the facility will be able to give you the number. If he or she doesn’t call you back within two business days (during the week), it’s already time to change doctors! In an emergency, the nursing home can always reach your physician or the assigned covering physician. (It’s the law!)
5. If you don’t understand a medication that has been ordered for your loved one, speak up to the nursing staff and question it. They can always get in touch with the physician to obtain an explanation for you. Remember, there are no stupid questions when it comes to nursing homes, especially when it relates to medication use.
6. Eat a meal at the facility. There is no better way to check the quality of the food being served than to eat a meal there yourself (you will probably be charged for the meal; this is a normal procedure). You may need to arrange for this in advance as the number of extra meals available for any given mealtime can be tightly controlled in most facilities. Most importantly, monitor the food and fluid intake of your loved one on a regular basis. Poor nutrition and dehydration remain leading clinical problems for many residents of nursing homes, especially in the latter stages of dementia-type illnesses. Regularly ask for and follow the monthly weights, which are required to be obtained in all nursing homes in the United States. If the weight is declining for more than one month in a row, request that the dietitian be called to consult (a physician’s order for this can be obtained by the nursing staff).
7. If the roommate sharing the room with your loved one is extremely loud and seems to be inappropriately matched, request a new roommate or a room change from the social services director. You have a right to request room changes although the availability of other rooms may be very limited at times.
8. Participate in the care planning conferences that are held on a regular basis (usually quarterly or more frequently as needed). Ask them to try to schedule these meetings at a time when you can attend or, if unable to be physically present, ask them to arrange a telephone speaker system to allow you to participate. These meetings review the care, physical assessments, medications and other issues that may be affecting the quality of life for your loved one in the facility. Be prepared to ask questions during the meeting if you have concerns or send a written list of issues to the facility that you would like discussed at the meeting.
9. Always keep an eye on grooming issues. If your loved one does not appear to have had their hair combed, teeth brushed or have clean clothing on, find out why. Check to see if others in the facility have similar grooming problems. Speak to the director of nursing or administrator if you feel the staffing ratio is chronically inadequate to provide the necessary care for the number and medical condition of the residents living on that particular section of the facility. Ongoing dental care is also very critical for overall good health and the family should continue to schedule regular checkups and cleanings at the family’s expense with your loved one’s regular dentist. Quality dental care on-site at the nursing home is extremely rare to find.
10. If restraints are being requested or ordered, make sure the facility has tried alternative methods prior to their use. Restraints should be a last resort for someone in a facility as they can contribute to further decline in functional status (weakness of leg muscles due to decreased walking) or injury (full bedside rails being used). Make sure the nursing department has completed an assessment regarding the need and potential benefit of any restraint being recommended. Restraint use should be monitored on a regular basis and the least restrictive method should be used whenever possible. Regular review of the continued need for restraints is required by law and attempts at reduction in their use should be considered when clinically appropriate.
It is important to know that Grandma, the nursing home resident, has rights under both federal and state law. The federal rights are found in the Code of Federal Regulations (C.F.R.), Title 42. The state rights are found in the Health & Safety and Welfare & Institutions Codes, and in the California Code of Regulations, Title 22.
Nursing homes are required to inform residents of these rights and protect and promote their rights. If a resident is incapable of exercising his or her rights, the person designated by law, such as conservator or attorney-in-fact, or in most cases, the next of kin may exercise these rights.
These rights include (but are not limited to) the right to be treated with dignity, right to receive the necessary care and services to attain or maintain the highest practicable physical, mental and psycho-social well-being, right to receive care to prevent bedsores and incontinence, and the right to be free from verbal, sexual, physical, and mental abuse, and corporal punishment.
If you have concerns that Grandma’s rights are being violated, start by communicating with staff of the facility or a family council if one exists. Another option is contacting the long-term care ombudsman office in your county for assistance (posted in hallways of nursing homes). The ombudsman program helps residents resolve concerns about their care and rights.
If your concerns are still not resolved, you can file a complaint about abuse, neglect and any other matter protected by law. For example, you can file a complaint about violations of your rights, poor care, lack of staffing, unsafe conditions, mistreatment, improper charges, transfer and discharge concerns, and a failure to readmit you after a hospital stay.
Any person (not just residents or their family members) or organization can file a complaint about a nursing home with the Licensing and Certification Division of the California Department of Public Health (DPH). DPH is the state agency that enforces nursing home laws and regulations through regular inspections and complaint investigations.
Judd Matsunaga, Esq., is the founding partner of the Law Offices of Matsunaga & Associates, specializing in Estate/Medi-Cal Planning, Probate, Personal Injury and Real Estate Law. With offices in Torrance, Hollywood, Sherman Oaks, Pasadena Fountain Valley, he can be reached at (800) 411-0546. Opinions expressed in this column are not necessarily those of The Rafu Shimpo.