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Message #682 Nursing homes: State regulations

mp3 #682 Nursing Homes - State Regulations (mp3 file)

Many of the things you should consider when selecting a nursing home are covered by state regulations. However, nursing homes do not always meet these standards as they should, so the following points are very important to consider when choosing a home. If the home you are looking at seems to fall short of these standards, you should bring the matter to the attention of the proper authorities.

Each nursing home, according to California law, must make available to the resident or his agent at the time of admission and on request written admission and discharge policies which explain the charges for care, for extra services, limitations of services, and the refund policies. Read these policies carefully and be sure you understand them. If anything is unclear, ask the administrator.

Nursing service is one of the most important points to consider the lack of proper training is one of the biggest problems in nursing homes, and the home should have in-service education programs for the staff.

Meet with the director of nursing. How long has she been in her position? Is she willing to talk to you? A rapid turnover of employees is not uncommon and it may indicate that conditions in the home are less than satisfactory.

Also observe if residents are well treated and groomed. Do they appear comfortable? Is their privacy respected? Are call lights answered quickly?

Watch how drugs are given to residents. They should only be given by a licensed nurse or doctor. There is the danger of drugs and medications being given in error, or being used unnecessarily to sedate residents.

The average nursing home resident takes from four to seven different drugs a day, so drug costs are an important economic consideration. The home may not require you to purchase drugs (or rent or purchase medical supplies or equipment) from a particular pharmacy. If the home requests that you use a particular pharmacist, check whether the home has compared the pharmacy's drug prices to those of other pharmacies in the area. The law requires that you be allowed to use your own pharmacist which means your friends or relatives can get your prescription filled for you at a drugstore of your choice. However, the pharmacy you choose may be required to comply with reasonable policies and procedures of the home.

Check the food being served. Make a visit at the time of the midday meal, which is usually the main meal. Sample the food yourself. Ask the other residents about the quality of the food. Does the dining room look large enough to hold all of the residents who will be eating their meals there? Does the food look appetizing and nutritious? Does it sit on trays too long before being served? Is the hot food hot, and the cold food cold? Is consideration given to residents' food preferences? California law requires that ot more than 14 hours elapse between the evening meal and breakfast, and that bedtime snacks be offered to all patients unless it is not medically advisable.

All licensed nursing homes are required to name someone in the facility in charge of resident activities. You should also check whether activities are developed for individuals who are confined to their rooms.

For a home to become licensed, it has to pass certain physical standards. However, you should check whether the home is clean, and does not smell of urine or heavy cover-up deodorant? You should also check whether the residents look clean and well-cared for. Check the home for safety. Make sure residents can get out of the building easily in case of an emergency. Are the fire evacuation routes posted? Are the passage ways well lighted and free of obstructions? Are there rails along both sides of halls and stairways for the resident who need them?

After you have answered many of these questions about the nursing home, be sure to make a second visit. Return unannounced during the evening. If resident morale is still good in the evening, you are probably visiting a good home.

You should also take the contract home and study it carefully before you sign it. Remember, you are liable for everything you sign.

Make sure you look at the nursing home's state and federal inspection reports which are required to be made accessible.

To a certain extent, outside observers can't measure many aspects of nursing home care which relate to the patient's health, safety and comfort. Therefore, you should look at the state licensing reports to get a better idea about the nursing home. Evaluators from the California Department of Health Services inspect the homes at least once a year. In the past the evaluators have been criticized for being too lenient. To increase their effectiveness, inspections are now unannounced.

Inspection reports are public documents which can be seen by anyone who asks for them. The home's most recent inspection report, as well as the plan of corrections of any violations, and the follow-up visit report must be accessible. The facility must also make accessible any revocation or suspension actions instituted against the facility during the current or prior licensing period. The reports are also available in the district offices of the Licensing And Certification Division, Health Care Section. There is a small copying charge. Some county health or social service departments also make these reports available.

The nursing homes are also surveyed annually or more often, if necessary, for compliance with Medicare and/or Medi-Cal standards. These results are included in the licensing and certification inspection report, but they are also available separately in local Social Security offices. You should remember that reports are an indication of past performance, and a nursing home is expected to correct problems. Serious violations must be corrected immediately while others must be corrected within a specific number of days or weeks.

The names and addresses of all previous owners must be posted. Changes in ownership, administrator or staff can produce changes in a home, and if your own impressions of the home differ from the inspection reports, you should keep any recent personnel changes in mind.

You should also realize that the kind of non-compliances the home has is as important as their number. Pay particular attention to problems of patient care, staff adequacy, and facility cleanliness and maintenance.

Violations can range from sterilizing instruments to physical abuse of patients. Class "AA" violations involve the death of a patient. Class "A" violations are also of a highly serious nature, and present imminent danger to the patients, and the substantial probability that death or serious physical harm will result. Class "B" violations, while not as severe, have a direct relationship to the health, safety or security of patients.

You should also note the degree of change from one inspection to the next. A record that improves dramatically from a great many non-compliances to a very few may simply be the result of pressure and may not outlast the inspection.

The California Department of Health Services' Nursing Home Regulations provide that citations can be issued to nursing homes which are in violation of California laws or regulations. Fines may reach as high $25,000, depending on the seriousness of the violation.

If you feel there is a reason to complain about a nursing home you visit or are in, don't hesitate to do so. A complaint can simply be in the form of a letter, and it is enough to trigger an investigation. The complaint must be in writing and signed. Include your name, address, and telephone number so the department can contact you. Keep a copy of your letter. It should be as detailed as possible, including a description of specific incidents, times, dates, and names of persons. The Department of Health Services must make an on-site inspection in response to the complaint, unless the complaint is judged to be totally unjustified. For complaints involving abuse or neglect, the inspection must take place within 24 hours of the complaint. The inspection must be unannounced, and the evaluator must not disclose the name of the person who initiated the complaint, if the complainant requests anonymity. The Department of Health Services will accept anonymous or phoned in complaints. There is also a toll free 800 number on the home's license, which must be posted. You can call this number with complaints. Complaints may also be directed to the ombudsman of the county in which the home is located. The ombudsman acts as a patient advocate. A nursing home operator who discriminates or retaliates in any way against an employee or patient may be fined up to $10,000. Any operator who discharges a patient within 120 days of that patient's complaint can be fined up to $10,000 unless the nursing home can prove that the discharge had nothing to do with the complaint.

The Licensing And Certification Division of the California Department of Health Services ( investigates complaints about nursing homes. Its local offices are located in Sacramento, Chico, Redding, Santa Rosa, Fresno, Berkeley, San Francisco, San Jose, Santa Ana, San Diego, Ventura, San Bernardino, Los Angeles Reseda, Santa Monica, Downey, and West Covina. The state headquarters office is in Sacramento at 1615 Capital Avenue, Zip Code 95814, telephone number 916-552-8700.

Nursing home complaints may be made on a toll-free number, which may be obtained from directory assistance, or from telephone directory.

The California Department of Aging has a State Long Term Care Ombudsman in its Sacramento Office, telephone 800-231-4024. The State Long Term Care Ombudsman Office will offer assistance in the processing of complaints about nursing homes, through its 35 local offices. For the various locations and additional information, the Department of Aging maintains a website at

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