NURSING
HOMES:
IDT & RESIDENT
RIGHTS
Natalie R. Baker, DNP
nrbaker@uab.edu
When you hear the word nursing home,
what is your first thought?
Common thoughts
Not so common thoughts
Old-folks home
Rehabilitation services
A place to die
Skilled nursing care
A depressing place
Staff trained to care for frail older adults
Poor care-urine smells, pressure ulcers
A safe home for older adults who need
assistance
Who pays for nursing home care?
Payment Sources
Medicare-Part A
Medicaid
VA
Commercial Insurance
Private Pay
http://www.skillednursingfacilities.org/articles/nursing-home-costs.php
Regulations Governing NH
Federal
42 CFR Part 483, Subpart B-Requirements for Long Term Care Facilities
State
VA
What healthcare disciplines are
represented at nursing homes?
Healthcare Disciplines
Nursing-RN, LPN, CNA
Physician Services-MD/DO, NP, PA
Dietary-RD, Dietary Manager
Rehab-PT, OT, SLP
Social Services
Hospice
Activities
Podiatry, Dental, Optometry
Comprehensive Care Plan
“The facility must develop a comprehensive care plan for
each resident that includes measurable objectives and
timetables to meet a resident’s medical, nursing, and
mental and psychosocial needs that are identified in the
comprehensive assessment.” 42 CFR 483.20
The Long Term Care Survey, May 2013 edition, p.17
Interdisciplinary Care Plans
“Prepared by an interdisciplinary team, that includes the
attending physician, a registered nurse with responsibility
for the resident, and other appropriate staff in disciplines as
determined by the resident’s needs, and, to the extent
practicable, the participation of the resident, the resident’s
family or the resident’s legal representative…” 42 CFR
483.20
The Long Term Care Survey, May 2013 edition, p.17
Frequency of Care Plans
14th day of admission
Quarterly-revise, develop new CP if needed
Significant Change-revise, develop new CP if needed
Annually-develop new CPs
Resident Rights
Why was it necessary for the federal government to enact
resident rights for nursing homes?
Resident Rights
“The resident has a right to a dignified existence, selfdetermination and communication with and access to
persons and services inside and outside the facility. A facility
must protect and promote the rights of each resident,
including each of the following rights:” 42 CFR 483.10
The Long Term Care Survey, May 2013 edition, p.5
Resident Rights
Exercise of rights-vote
Notice of rights and services-must receive a copy
Access to all MR within 24 hours of oral/written request
Copy of all MR within 2 working days-reasonable cost
NH must post contact information of advocacy groups
Physician contact information
Significant condition change reported to MD & family
Change in room or roommate
Resident Rights
Protection of resident funds
Free choice
Choose a personal attending physician
Be fully informed in advance about care and treatment
Participate in care and treatment plans
Privacy and confidentiality
Grievances
Voice grievances without discrimination or reprisal
Resident Rights
Examination of survey results
Work
Mail
Access and visitation rights-NH must provide immediate access
Physician
State representative
Ombudsman
Family
Resident Rights
Telephone
Personal property
Married couples
Self-administration of drugs
Refusal of certain transfers
Relocation from SNF area to non-SNF area
Relocation from non-SNF area to SNF area
Additional Resident Rights
Free from physical or chemical restraints if imposed for purpose
of discipline or convenience
Free from verbal, sexual, physical, and mental abuse, corporal
punishment, and involuntary seclusion
Organize and participate in residents’ groups
Participate in social, religious, and community activities
Self-determination
Self-Determination
“The resident has the right to
1) Choose activities, schedules, and health care consistent with his or her interests,
assessments, and plans of care;
2) Interact with members of the community both inside and outside the facility; and
3) Make choices about aspects of his or her life in the facility that are significant to the
resident.” 42 CFR 483.15
The Long Term Care Survey, May 2013 edition, p.14